New Customer Form

Name(Required)

Company Name(Required)

Business Phone:(Required)

Fax:

Cell:

Billing Address:

Street Address City State / Province / Region ZIP / Postal Code

Shipping Address:

Street Address City State / Province / Region ZIP / Postal Code

Payables Email:

Purchasing Email

Preferred Invoice Method:

Mail

Do you require Purchase Orders?

Yes

Fed Tax I.D. #:

County:

WA Reseller Permit#

Are you A?

Corporation

Partnership

Proprietorship

Years In Business

Additional Authorized Employees

First Name:

Last Name:

Position:

Phone:

First Name

Last Name

Position

Phone

First Name

Last Name

Position

Phone

If this account request is opened, I agree:

When providing a credit card, you are agreeing to pay at the time of invoice. CC must be put on file for rentals.
To pay interest of 1.5% per month on any invoice past its due date.
To pay collection agency fees, attorney’s fees and all court costs in the event that collection efforts become necessary.
To pay each invoice no later than 3 days following the date of invoice. If paying with a CC there may be 3% Fee, if you would like to be set up as a Net 10/Net30, please let us know when emailing this back that you would like to get a credit review completed. Please be aware that a credit approval may not be given immediately.

- This (item#4) does not apply to rentals. Rentals must be paid at time of invoice & CC must be on file.

Authorized Name:

Title

Authorized Signature:

Date

Please call us at (503) 256-7330 with credit card payment information to complete your setup in our system.

New Customer Form

New Customer Form

Additional Authorized Employees

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