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Out-Standing Photos, Inc. |
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| Professional Account
Application
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| Company Name: _________________________ | Contact Name: ___________________________ | |||||||||
| Tel: (_________) _________________________ | Fax: (_________) _________________________ | |||||||||
| Email: _________________________________ | Web Site: _______________________________ | |||||||||
| How long in business? ____________________ | Tax ID #: ________________________________ | |||||||||
| Shipping Information | Billing Information (if different) | |||||||||
| Address: _______________________________ | Address: ________________________________ | |||||||||
| City: ___________________________________ | City: ____________________________________ | |||||||||
| State: __________________ Zip: ___________ | State: __________________ Zip: ____________ | |||||||||
| Country: ________________________________ | Country: _________________________________ | |||||||||
| Please select a payment option | Payment Information | |||||||||
| [ ] I will enclose a check with each order I submit. Only charge card on file if payment is not enclosed or past due. | All accounts must have
a credit card number on file regardless of payment options requested. Credit Card [ ] Master Card [ ] Visa Card Number ____________________________ Expiration Date Month _____ Year __________ Signature _______________________________ |
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| [ ] Charge the card on file automatically for each order submitted. | ||||||||||
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