EVOS New Account Registration Form

Company Name *

Is This Also Delivery Address *

Yes No

Tax Exempt ? *

Yes No

Exemption #

*If exempt, EVOS,Inc will need copy of your exemption letter for our files.

Main Contacts:

Name

Phone#

email

Purchasing

Accounts Payable

Manager/Owner

Does your company require purchase order?

Yes No

Business Information *

Number of years in business?

Number of total employees?

Number of total office employees?

1.

What payment terms would your company prefer?

Net 30 Billing Credit Card

How would you like to receive invoices?

US Mail Email

email address:

Please List all Employees that are authorized to place orders:

Name:

Phone:

Email:

1

2

3

4

5

Approval

Need Approval?

1

2

3

4

5

If Yes,Approver's Name:

If Yes, Approver's Name:

1

2

3

4

5

General Information Regarding This Application:

By clicking the "Agree" button below, you are indicating that the information on this form is herewith submitted for the purpose of opening an account with EVOS, Inc and that you hereby certify that the information is true and correct to the best of your knowledge. You indicate that you are an authorized representative or corporate officer of the above named business. You also indicate that you understand and intend to comply with the payment terms extended to your business.

If setup on account, invoices will be delivered to you as specified above. A monthly statement will be delivered as well. Terms are NET30 from invoice date. Other billing options are available upon request by calling EVOS, Inc at (480) 497-0407.Any account that is delinquent in paymnet can be put on credit hold at the discretion of EVOS, Inc. Any balance exceeding 90 days past due can be turned over to collections at the discretion of EVOS, Inc. Any fees associated with the collection effort will be added to the account balance of the over-due account.

EVOS, Inc will at times send out general information, company news, product specials, promotions as well as other marketing materials. If you do not wish to receive coorespondance, please email our customer service at customerservice@evosinc.com or call us at 480-497-0407.

Please Note Any Special Requirements or Comments Here:

Name: *

Title: *

Date: *

*

I accept the terms and conditions