Account Setup

Company

First Name

Last Name

Address

City

State

Phone

Zip Code

Email

Accounts Payable Contact Name

Billing Address (if different)

Method of receiving invoices?

Email Mail Both

Does your company require purchase orders?

Yes No

Preferred method of payment?

Bill Me ACH Credit Card (a representative will call for this information)

Primary Contact Name

Primary Contact Address

Primary Contact City

Primary Contact State

Primary Contact Phone Number

Primary Contact Zip Code

Primary Contact Email

Secondary Contact Name

Secondary Contact Address

Secondary Contact State

Secondary Contact Phone Number

Secondary Contact Zip Code

Secondary Contact Email

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Account Setup

Set up an Account with Azzur Labs