AUTOMATIC PAYMENT ACCOUNT APPLICATION

Name of person opening the account: *

Firm's Legal Name *

d/b/a if applicable

Contact phone number of person opening the account *

Do you require references for your orders and invoicing needs?
To help sort your bill you can have references attached to each order and then have the invoice subtotaled accordingly.
YesNo

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 *

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, you confirm acceptance of the terms and conditions of this Agreement. You are responsible for all amounts owed on this account, whether charged by you, 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.

RECURRING BILLING CONSENT FORM: *
The undersigned consents and permits RTD LOGISTICS, LLC, dba Skycom Courier, to charge my credit card account specified above, as updated from time to time (“Card Account”), any amounts due for services provided to me by Skycom Courier during the applicable billing cycles, unless and until Skycom Courier has received notification in writing from me that I have withdrawn such consent and permission. By way of this consent form, the undersigned agrees that Skycom Courier may be advised by credit card company of any changes to the status of the Card Account, including updated account number and expiration date information, to ensure my uninterrupted service by Skycom courier.

PAYMENT TERMS: *
Unless other terms are arranged, payment is due within 15 days of the billing date. If this account becomes overdue, Skycom Courier reserves the right to suspend service, without notice, until unpaid and overdue balances are paid. You agree to pay all costs of collection, including reasonable attorneys' fees, incurred to collect unpaid and overdue balances.

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 *

Title *

Today's Date *.