Customer Agreement with Combined Resources, Inc.

Section I - FEDERAL W9 LEGAL INFORMATION

Business Name

Company DBA (if applicable)

Year Business Established

IF LLC, enter the Tax Classification (C = C Corp, S = S Corp, P = Partnership)

Other Classification (if not listed)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Company Address (number, street, and apt. or suite no.)

City

State

Zipcode

List Account Numbers (if applicable)

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Section II - CREDIT VERIFICATION INFORMATION

Bank Account TypeSavingsCheckingOther

Bank Name

No. of Years Banking at Bank

Bank Address (number, street, and apt. or suite no.)

City

State

Zipcode

Bank Key Contact Name

Bank Key Contact Email

Bank Key Contact Phone Number

Section III - BUSINESS/TRADE REFERENCES

Reference1 Company Name

Contact Name

Contact Email

Contact Phone

Street Address

City

State

Zipcode

Reference2 Company Name

Contact Name

Contact Email

Contact Phone

Street Address

City

State

Zipcode

Reference3 Company Name

Contact Name

Contact Email

Contact Phone

Street Address

City

State

Zipcode

Section IV - CUSTOMER AGREEMENT

I accept the below terms:

Payments to CRI	* CRI Invoices are DUE UPON RECEIPT until adequate payment history is established. * Please include CRI's Invoice# on all CRI payments made. * Please do not submit payments before receiving a CRI Invoice. * Email [email protected] for CRI Invoice help.
Payments from CRI	* Should you have Invoices for CRI, please submit [email protected]. * CRI will pay on your Payment Terms.
ACH Information	* CRI prefers ACH - - physical checks are accepted. * Request CRI’s ACH bank information by emailing [email protected].

PLEASE READ ALL OF THE ABOVE REQUIREMENTS, ADD THE BELOW CONTACT INFORMATION, SIGN, AND SUBMIT.

Key Contact Name

Key Contact Email

Key Contact Mobile Number

Key Accounting Contact Name

Key Accounting Contact Email

Key Accounting Contact Mobile Number

Key Dispatch Contact Name

Key Dispatch Contact Email

Key Dispatch Contact Mobile Number

Name of Authorized Signer

Email of Authorized Signer

Digital Signature

I agree to pay Combined Resources Inc’s (CRI) invoices upon receipt and to never exceed 30 days past due.
Claims arising from CRI invoices must be made within five working days.
By submitting this application, you authorize Combined Resources, Inc. to check the above references and perform credit worthiness through D&B or a comparable credit check service.

Customer Agreement with Combined Resources, Inc.