Company Profile Form

Basic Information

Company Name(*)
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DBA Name(*)
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Company Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Phone(*)
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Fax(*)
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Authorized Contacts

Contact One Name(*)
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Contact One Email(*)
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Contact One Phone(*)
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Contact One Ext.
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Contact Two Name
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Contact Two Email
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Contact Two Phone
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Contact Two Ext.
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Contact Three Name
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Contact Three Email
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Contact Three Phone
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Contact Three Ext.
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Accounts Payable Contact Information

Full Name(*)
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Email(*)
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Address
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City(*)
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State(*)
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Zip Code(*)
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Phone(*)
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Ext
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*Terms of payment are Net 7. A services charge of 1.5% per month (18% per annum) shall be charged on all past due accounts subject to a minimum service of $5.00 per month. In the event it shall become necessary to collect for the herein above described service, or any part thereof, the purchaser agrees to pay all costs, including reasonable attorney’s fees. (If other terms of payment are needed, please contact Sales at 256.585.1054)

Type Numbers(*)
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