eLabs COD Form
https://www.elabsinc.net
Your Company's Legal Name
*
(DBA) Doing Business As
*
Principal Owners Name
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Is Shipping/Physical Address different than Billing Address
Please Select
No
Yes
Federal ID, Entity ID, Business, Filing, Charter,Control, Trade Registration Number, or Name
*
Sales tax exemption status?
*
Charge Sales Tax
Resale
Government exempt
Tax Exemption #
*
Upload Tax Exemption Certificate - THIS IS REQUIRED TO COMPLETE THE SUBMISSION Browse Files
Browse Files
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Choose a file
Cancel
of
Upload W9 - THIS IS REQUIRED TO COMPLETE THE SUBMISSION
Browse Files
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What will be purchased?
Parts
Service
Equipment
Construction
Payment Type
*
Cash
Credit Card
Money Order
Check
I hereby give eLabs Inc authorization to charge for all orders:
Name
*
First Name
Last Name
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Debit/Credit/Billing Card #
*
Debit/Credit/Billing Card Security Code #
*
Signature
eLabs Inc. requires payment for all orders lacking a completed application. Customers are requested to provide the necessary credit card information or contact eLabs Inc. to obtain a application. Any delinquent invoices or statements shall accrue interest from the due date at the maximum non-usurious rate permitted under applicable law. The Customer agrees to reimburse, and eLabs Inc. shall be entitled to recover, all costs and expenses incurred in connection with the collection of delinquent accounts, including, but not limited to, reasonable attorney’s fees (whether incurred at trial, on appeal, or in bankruptcy proceedings), court costs, and collection agency fees. The undersigned hereby represents and warrants to eLabs Inc. that they have reviewed and fully understand the terms and conditions of this application and agreement, and that all information provided herein is current, accurate, and complete.
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