New Customer Setup Form

New Customer Setup Form
Business Information
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone #*
Account Contact Information
Account Contact Name*
Title*
Telephone*
Email*
example@example.com
Billing Information
Billing Contact Person*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Phone #*
Billing Email*
example@example.com
Billing Term*

CODNET 30
Are you tax exempt on towing services?*
Tax Exempt #*
Upload Tax Exemption Certificate*

Cancelof
P.O. # Required?*

YESNO
You hereby agree that you are authorized to set up this account on your companies' behalf. Any services performed by Capital Towing & Recovery must be paid for in accordance with the terms set forth above.
Signature*

Clear
Print Name*
Title*
Date*

MonthDayYear
Should be Empty:

Business Information