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Orders can be phoned into the PCS Order Desk at (919) 266-4463 (voice mail 24 hrs) or faxed to (919) 266-7643. Confirmation will be phoned or faxed per your preference. The following information is requested for our files and will speed our deliveries to your door. More Information
REFERENCE FILE INFORMATION FOR
C.O.D. SHIPMENTS OR MASTERCARD/VISA SHIPMENTS ONLY
**COD SHIPMENTS REQUIRE MASTERCARD/VISA NUMBER AND
EXPIRATION DATE OR BANK ACCOUNT
INFORMATION ON FILE PRIOR TO SHIPMENT**
(This is NOT a credit application. Open accounts require prior approval of an "Open Account" application)
Mastercard/Visa #_______________________ Exp. Date___________
Name on credit card, EXACTLY as it appears. _____________________________________
Company Name: _____________________________________________________________
Ship to Address: _____________________________________________________________
__________________________________________________
__________________________________________________
Bill to Address: ______________________________________________________________
__________________________________________________
__________________________________________________
Accounting Contact: ____________________________________________
Phone #: _____________________________________________________
Fax #: _______________________________________________________
TAX STATUS: ___Direct Pay
___Exempt-Resale ___Exempt-Mfg
___Fully Taxable
(Exemption Certificate is required with application or sales tax will
be charged on all purchases.)
County in which Business is Located: _____________________________________________ (required)
Bank Reference: ____________________________________ Account #________________________
Phone #: ____________________________ Contact:_______________________________________
The undersigned individual authorizes Photo Chemical Systems, Inc. to make inquiry from the reference given above and other financial credit sources for verification for credit reliability.
The undersigned authorizes Photo Chemical Systems, Inc. to make charges for phone orders to the credit card account listed above unless other term arrangements are agreed upon at time of order.
We understand that all products are sold without warranties expressed
or implied. We further agree to pay any collection costs incurred to collect
the account balance, including court costs, collection fees and attorney's
fees of not less than 33% of the unpaid principal. (More
information)
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Date |
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(Rev. 11/97, internet version 10/98)
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