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308610066675PROper Technologies, Inc.29115 State Highway 27Guys Mills, PA 16327Phone: 814-789-2768Fax: 814-789-3333 accounting@00PROper Technologies, Inc.29115 State Highway 27Guys Mills, PA 16327Phone: 814-789-2768Fax: 814-789-3333 accounting@New Customer ApplicationDate _________________________ Salesperson _____________________________Company Name ________________________________________________________________Primary Contact _________________________________Title ___________________________Telephone _______________ Fax _______________ Email _____________________________Billing Address _________________________________________________________________City _________________________________ State ____________ Zip ____________________Shipping Address _______________________________________________________________City _________________________________ State ____________ Zip ____________________Shipping Charges Prepay and Add to Invoice UPS Collect #______________________Payment Terms Pre-Credit Approval Credit Card NET 30A 4% Service Charge will be added for Credit Card payment.Pre-Credit Approval Release of OrderI/We _____________________________________________ understand that the credit approval process has not been completed on our account. However, we agree to accept one of the following temporary payment terms: COD Visa MasterCard American ExpressCredit Card Number _______-_______-_______-_______ Expiration Date _____ /_____CVV (3 digits on back of Visa or MasterCard) _________CVV (4 digits on front of AMEX) _________Zip Code of Credit Card Billing Address __________Email Address for Receipt ________________________________________________________Signature of Cardholder/Company Representative _____________________________________ Rev 2.18.2020 ................
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