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BILLING ADDRESS (IF DIFFERENT THAN ABOVE)
COMPANY OFFICER OR ACCOUNTS PAYABLE CONTACT
TERMS OF CREDIT

All accounts are due when rendered. Interest @ 2% monthly will be charged on all invoices which are more than 30 days in arrears. Payments are to be made to head office.

By submitting this form, I agree that all of the above information is accurate. The submission of this form will act as my handwritten signature.