Account Setup Form & Net Terms

Account Setup Form & Net Terms
Organization Name*
Address (Invoice Mailing Address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Primary Point of Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Billing & Invoicing
Upon receiving a new Purchase Order an Invoice will be generated. Please indicate below how payment will submitted.*

CheckCredit/ACH Authorization FormOther
Net Terms Credit
I/Authorized Signer will not be on cash terms but on A/P Net Terms (10) days.*

Yes
By signing below, I certify that I have the authority to bind the company to this agreement, and that I agree to creditor's terms of sale of net ten (10) days. I also, agree and accept that the credit limit and credit terms may be changed or withdrawn at the sole discretion of the creditor. Creditors shall include creditor subsidiaries, related companies, and assigns. The information herein given is offered as part of a request by the applicant for an extension of credit for commercial business use.
Authorized Signer*

First NameLast Name
Authorized Signer Organization Role*
Signature*

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Billing & Invoicing