ACCOUNT INFORMATION
Date:
Business Name: *
Website Address (URL)
Billing Address (Street) *
City*
State*
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Zip*
Telephone No.: *
Fax No.:
E-mail
Contact Person: *
Federal ID or SS# *
Where and how did you hear about Tharling Appliance A/C & Heat
PERSON RESPONSIBLE FOR PAYMENT (If Business is Sole Proprietorship)
Check if same as above
Name:*
Personal Address:*
Business Phone No.:*
Personal Phone No.*
ACCOUNTS PAYABLE DEPT. INFORMATION (If Business is a Partnership or Corporation)
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Reference 2*
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Bank Name & Address*
Bank Account Number*
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