Please enable JavaScript in your browser to complete this form.Company Name *Company Physical Address *Phone number *Contact Name *FirstLastPreferred Payment Terms *30 Days45 Days60 DaysPreferred Method of Payment *Check (EFS, Comcheck, T-Check Accepted)Virtual Credit CardOther (Specify Below)If Other, Please explainDo you require a Purchase Order number or Reference number? *Purchase OrderReference NumberNoneIs your Business Tax Exempt? If so, you will be asked to provide your Tax Exempt form *(Select)YesNoOnce Service is completed, What is your invoicing process? *Email for invoices to be sent to: *EmailConfirm EmailFax Number if required for invoicingCompany Mailing Address *Accounts Payable Contact Name *FirstLastAccounts Payable Point of Contact Phone number *Accounts Payable Contact Email *EmailConfirm EmailApplication Terms and Conditions Acknowledgement *I agreeI do not agreeI am aware that this is an application to open an account with Candido's Towing and Repair and that the information I have provided here is correct to the best of my knowledge. My typed name below and date is my confirmation.Typed Signature and Date *FirstLastSubmit
