Company/Customer Account Information

Company Name

First

Billing Address

Street Address Address Line 2 City State ZIP Code

County

Delivery Contact

First Last

Delivery Address

Street Address Address Line 2 City State ZIP Code

County

Phone

Federal ID#

State ID#

State Sales Tax#

Federal Q#

Tax Exempt

Yes

(If Tax Exempt upload copy of Tax Exempt Certificate)

Tax Exempt Certificate

Max. file size: 50 MB.

Phone Number

Toll Free Phone Number

Fax Number

Company Owner/President

First Last

Years in Business

Corp.

Partner

Sole

Email Address

Name of person handling Accounts Payable

Phone

MSO (Manufacturers Statement of Origin)

Company/Person's Name to be listed on MSO

Address MSO should be mailed to

City

State

Zip

Felling Trailers, Inc. will release the trailer(s) MSO (Manufacturers Statement of Origin) upon receipt of Full payment of trailer. The information provided on this form is for the purpose of setting up account and order information. Company/Customer agrees to pay all invoices according to the terms stated. A 1.5% late fee per month will be charged on any amounts overdue, with a $ 5.00 minimum. If the account is placed for collection, the Company/Customer will be responsible for and remit all fees.

Signature

First Last

Title

Date

REV. A Company-Customer Account Information Form 2023 Marketing Drive Forms 2.7.23

Company/Customer Account Information

Company/Customer Account Information

Federal Health Care Price Transparency Requirements