Finance Set-Up Form

FINANCE SET-UP FORM

This Finance Set-Up Form authorizes the recipient to establish billing and payment arrangements, obtain credit references, and, where applicable, initiate electronic transfers for payment. All information provided will be used to evaluate financial terms and to process payments in accordance with the terms set forth below.

Company Information

Client Name:

Corporation   LLC   Partnership   Sole Proprietor   Nonprofit/Government   Other:

Tax and Registration

Sales Tax Exempt: Yes   If exempt, Permit / Resale Number:

Accounts Payable Contact

Phone:    Email:

Preferred Invoice Delivery: Email   Mail   Portal/EDI   If Email, send to:

Payment Method and Banking Details

Accepted Payment Method for this account (select all):   ACH Debit/Credit   Wire Transfer   Check   Credit Card

Routing Number:    Account Number:

Account Holder Name:

Credit Terms and Limits

Requested Payment Terms: Net 30   Net 45   Net 60   COD   Other:

Late Payment Policy: Accounts not paid by the due date will incur a late fee of 1.5% per month (18% APR) on past due balances, plus reasonable collection costs and attorneys' fees. By applying, the applicant agrees to the stated late fee policy and collection costs.

Authorization to Obtain Credit: Applicant authorizes the recipient to obtain credit reports and trade references as necessary to evaluate creditworthiness.

Trade / Credit References

Contact:    Phone:    Account #:

Contact:    Phone:    Account #:

Contact:    Phone:    Account #:

Notes, Special Instructions, Terms & Conditions

By signing below, the undersigned certifies that the information provided in this Finance Set-Up Form is true, complete, and accurate. The undersigned authorizes verification of any information provided, including credit inquiries and financial references. The undersigned further authorizes the recipient to initiate debit and/or credit entries to the designated bank account for invoice payments where ACH debit agreements are in place; such authorization will remain in effect until revoked in writing with reasonable notice. The applicant agrees to indemnify and hold harmless the recipient for actions taken in reliance on the information and authorizations provided herein, except to the extent caused by the recipient's gross negligence or willful misconduct.

Data Security and Privacy: The recipient will maintain reasonable administrative, technical, and physical safeguards designed to protect confidential financial information. The applicant acknowledges that transmission of banking information carries inherent risk and agrees to assume responsibility for accuracy of submitted payment instructions.

Certification: I certify that I am authorized to execute this form on behalf of the applicant and that the applicant accepts the terms and conditions stated above.

Acknowledgment and Authorization

Electronic Payment Authorization: Applicant authorizes electronic payments and agrees that electronic remittance is a legally binding payment method for invoices issued under this account.

Cancellation: Either party may terminate the payment arrangements established by this form upon providing thirty (30) days' written notice. Termination does not relieve the applicant of liabilities incurred prior to termination, including outstanding invoices and applicable fees.

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