Billing Agreement
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Company Name
*
Name
*
First
Last
Phone
*
Email
*
Fax
EIN/SS#
Billing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How many properties do you manage?
Who else is authorized to sign under this account? Please list Below.
*
Account and Billing Terms:
You will be issued an account number. Please use this number when placing orders to ensure accurate billing. Payment is due before the 15th of the following month for all invoices received by the end of the previous month. A $25 fee will be added to late payments.
I understand and agree to the above terms and conditions, and am authorized to order work and sign on behalf of the above company and/or person.
Would you like to place a credit card on file for future payment?
Yes
No
Signature
Clear Signature
For further clarification regarding questions or inquiries you may have, please reach out to us via phone at: 512-648-6464 or via email at: accounts_3@rekey.com
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