Customer Set Up Form - Alwin Machinery Sales

New Customer Set-up Form

New Customer Set-up Form:

Company Name

Company Tax Exempt #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Contact person to send Service Orders:

Name:

Contact person to send Estimates:

Name:

Contact person to send Invoices:

Name:

I certify that I am authorized on behalf of

to authorize the payment of invoices. I authorize Alwin Machinery, Inc. to keep the following payment information on file to use to automatically pay our outstanding invoices at Net 15. Alwin Machinery will send invoices and payment receipts to us for our records.

We prefer these communications to be via

Mail Attn:

Both

Credit Card:

American Express

Visa

Master Card

Amount in the of :

Expiration Date :

Account #

Security Code:

ACH Check Debit: I authorize Alwin Machinery, Inc. to initiate either an electronic debit or to create and process a demand draft against my bank account for our invoice amount. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law.

Account in the name of:

Bank Routing /ABA#

Bank Account #

Customer Signature:

Max. file size: 100 MB.

Date: