Eagle Crane Customer Application

Thank you for taking the time to fill out our customer application so we can start working together!

Company Name

Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Accounts Payable Contact

Accounts Payable Email

Visa or Mastercard Number:(Will be authorized and processed for first time customers)

Cardholder Name

Expiry Date

Terms: Accounts shall be due & payable 30 days after invoice date (the "due date") and shall bear compound interest at a rate of 1.5% per month (19.56% per annum) from the due date until paid in full

Eagle Crane Customer Application

Eagle Crane Inc.