COD Form
Customer Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
FAX Number
Please enter a valid phone number.
Bank Name
*
Bank Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Contact Name
Customer Bank Account
*
Drivers License
*
Returned Check charge is $30.00
Customer Signature (Must be signed by Owner. Please send Certificate of Sales Tax if Exempt. Must fill out attached W-9)
*
W-9 File Upload
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