Billing Information
Company Name
Billing Address
City, State, Zip Code
Billing Phone Number
Billing Email Address

Accounts Payable Contact
Name
Phone
Email Address

Credit References
Company Name	Company Name
Phone Number	Phone Number
Account Number	Account Number
Company Name	Company Name
Phone Number	Phone Number
Account Number	Account Number

Will Purchase Orders Be Issued?	Are Purchase Orders Required?

All invoices are due and payable within 30 days of invoice date. Invoices paid after that time will be subject to a 1.5% finance charge. Signature on this document indicates agreement to these terms.

Signature	Date