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30 Day Term Account Application
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2017-10-23T19:49:51+00:00
30 Day Term Account Application
Name of person opening the account: *
Contact phone number of person opening the account *
Firm's Legal Name *
Persons Email *
d/b/a if applicable
Do you require references for you orders and invoicing needs?
To help sort your bill you can have references attached to each order and then have the invoice subtotaled accordingly.
Yes
No
How did you hear about us?*
Billing Address
Street Address *
Room# *
City *
State *
Zip Code *
Main business phone number if different than above
Person in charge of processing bills *
Persons Title *
Persons Email *
Main Contact's Email:*
Billing Terms and Conditions
This is the Agreement that establishes your Client account with us and the terms and conditions of your account. *
By requesting and permitting us to provide delivery services to you the Client, Client confirms acceptance of the terms and conditions of this Agreement. Client is responsible for all amounts owed on this account, whether charged by the Client, a person whom you permit to use your account to order services from us, or any other person using your account with actual, implied or apparent authority.
PAYMENT TERMS: *
Unless other terms are arranged, payment is due within 15 days of the billing date. If this account becomes overdue, RTD reserves the right to suspend service, without notice, until overdue balances are paid. Should this account be placed with a collection agency and/or law firm, fees will be added to the balance due.
INSURANCE: *
All deliveries are insured for $100.00. If you would like to declare a greater value on a shipment, the value must be declared and insurance must be purchased prior to the time of shipment.
Printed Name and Electronic Signature *
Electronic Signature Agreement *
I Accept
By checking the "I Accept" checkbox above, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By checking the "I Accept" checkbox above using any device, means or action, you consent to the legally binding terms and conditions of this Agreement.
Title *
Today's Date *
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