Customer Accounts Payable Form

"*" indicates required fields

Customer*

Main Telephone*

Bill To*

Street Address Address Line 2 City State ZIP Code

Accounts Payable Contact*

First Last

Accounts Payable Contact Email*

Accounts Payable Email (if different)

Accounts Payable Telephone*

Accounts Payable Fax

Tax Exempt*

Yes

If yes, please email a copy of your tax exempt certificate to AR@TotalScopeInc.com or provide below.

Upload Tax Exempt Certificate

Max. file size: 50 MB.

Customer Terms

Special Payment Terms

GPO Affiliate

If multiple, who is primary?

Primary Method of Billing*

Paper

Billing Email

Primary Method of Payment*

Electronic/ACH

Credit Card/Purchase Card

Check

Notes