Atlas Delivery Services - New Account Setup

New Account Setup

Company Information
Name of Company or Individual

Parent Company

Address			Years at Address

City	State	Zip	Area Code	Phone

E-mail Address * Required

Billing Information
Billing Address

City	State	Zip	Area Code	Phone
				Attention

Type Of Business		Year Established

Bank Reference Branch		Bank Address

Bank Office or Department		Phone

Account Numbers:(General)		Account Numbers:(Other)

Please check basis on which you usually pay bills:
15 Days 30 Days
References
Business Name	Complete Address			Phone



I certify that all information on this form is correct. I fully understand your credit terms and agree to the proper payment in consideration of extended credit.