New Customer and CC Authorization Form - Compu-Net Systems | Managed IT Services | Cleveland, Ohio and Bluffton, South Carolina

New Customer and Credit Auth

Billing Address

Billing Address Line 1

Billing Address Line 2

City

State

ZIP

County

Phone

Mailing Address

Mailing Address Line 1

Mailing Address Line 2

City

State

ZIP

County

Phone

Primary Contact Information

First Name

Last Name

Primary Contact Email

Primary Contact Phone

Primary Contact Alternate Phone

Billing Contact Information

Invoices will be sent to the Billing Contact email address (if specified), or to the Primary Contact email address

Billing Contact is the same as Primary Contact?

Yes

First Name

Last Name

Billing Contact Email

Billing Contact Phone

Billing Contact Alternate Phone

Tax and Billing Information

Business customers: We ask for your Federal Tax ID Number because we are extending credit to you. If you prefer to not provide a Federal Tax ID or Social Security Number, payment in advance or having a valid credit card on file is expected.

Federal Tax ID (TIN)

Tax exempt?

Tax exempt

Our Accounting department will contact you to obtain a copy of your Certificate of Exemption. Alternatively, you may FAX it to +1.440.273.3364.

Payment Preference

Pay by check

Pay by credit card or bank (ACH)

Select one credit card or bank (ACH) processing option:

I give permission to Compu-Net Systems LLC to charge my credit card or bank (ACH) on, or just before the due date, for all invoices

I give permission to Compu-Net Systems LLC to charge my credit card or bank (ACH) on, or just before the due date, for recurring invoices only. I will provide approval via email or phone to process payment for all other invoices

Do not charge my credit card or bank (ACH) for any invoice until I provide approval via email or phone to process payment

Acknowledgements

By checking this box, I understand and agree to pay and specifically authorize Compu-Net Systems LLC to charge my credit card or bank for computer services including labor charges, hardware, software, travel, shipping, and any required sales taxes. I understand that my card or bank details will be stored in my profile and will only be used for approved purchases. I further agree that in the event my credit card or bank information becomes invalid, I will use the secure portal to update the information or contact Compu-Net Systems LLC with updated valid credit card or bank information upon request. I understand that I may cancel auto/recurring payments by contacting Compu-Net Systems Accounting but cancellations must be received at least 1 week prior to the next auto/recurring payment.

NOTE: When your account is setup, we will email you a link to create a password for our secure online portal. This portal will give you access to review service orders, quotes, and invoices. If you will be paying by credit card or ACH, you may securely enter your information for paying invoices in the portal.

Name (First and Last)

Date

Special Instructions

Message (max 2048 characters)

I have reviewed and agree to Compu-Net Systems LLC Terms, Warranty, and Disclaimer.

Customer and Credit Card Auth

Company Information

Billing Address

Mailing Address

Primary Contact Information

Billing Contact Information

Tax and Billing Information

Acknowledgements

Special Instructions

Cleveland, Ohio

Bluffton, South Carolina

Thank you!

Best Practices Guide