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Your PayChoice Rep.:
Company Name:
Contact Name:
Phone:
Fax:
Email:
Number of Employees:
Purchasing Contact:
Accounts Payable Contact:
Multiple Ship To Locations?:	Yes  |  No
	List Locations:
Cost Center Are:	Required  |   Optional  |   Not Used
	List Cost Centers:
Internet Ordering:	Yes  |   No
Credit Cards:	Use Credit Card
or Credit Line:	Want to be billed, contact for credit app.
If Credit Line Is Established
Invoices Should Go To:	Ship To
	Other (Please List Below)
A/P Prefers Invoices:	Monthly   Weekly   Daily   Per Shipment
Invoices:	Hard Copy  |   Electronic Format