(Signature of card holder)
TON SERVICES FAX MAILBOX APPLICATION
Please Mail or Fax to: TON Services, 4185 Harrison Blvd., Ogden, UT 84403 Fax:
801-624-4530
| Company Name | Date | |
| Mailing Address | City & State | Zip |
| Street Address | City & State | Zip |
| Telephone #: | ||
| Contact Person | Extension | |
| Fax #: | How long in business? | |
| Required Financial Information | ||
| Bank Reference | Account Number | |
| Name | Address | |
| Phone | Contact | |
| Payment Method (circle one) There is a minimum billing of $35 per month | ||
| Invoice Visa MasterCard Discover American Express | ||
| Name on Card | ||
| Credit Card Number: Expiration Date: | ||
By choosing a credit card pay option you authorize TON
Services to charge your selected credit card immediately upon purchase of
services.
(Signature of card holder)
Please read and sign below: Applicant authorizes bank reference to release credit information to TON Services and authorizes a credit report on Applicant and any officer and owner of Applicant. Applicant hereby agrees that TON Services extension of credit to Applicant pursuant to this application shall constitute applicant’s agreement to comply with and be bound by all the terms, conditions and agreements contained in the then effective “TON Services Agreement,” a copy of which is attached hereto or shall be mailed to applicant with TON Services notice of credit approval.
(Signature of Applicant)
(Title)
(Date)
Please include “Terms and Conditions”