
| Please take a few minutes to give us your preferences. |
| Advantages of Electronic Invoicing: |
| Choose One: |
|---|
| E-mail my invoices/statements. |
| Fax my invoices/statements. |
| Please do not send invoice/statements. I will review/print them online. |
| I would like to set up Web Order Entry. |
| Company Name | ||
| Account Number | ||
| Home Branch | ||
| Authorized Contact Name | ||
| Authorized Contact Title | ||
| Email address | ||
| Fax Number | ||
| Phone Number | ||
| Please press Submit or fax the completed form to |
| 330.252.0952 Attn: Accounts Receivable |
| Or Call Us at 330.762.9621 |