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New Account Request Form

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Name:    
Business Firm:  
Relation Or Position With Firm:    
Business Address:  
Suite:
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Agreement for collection Expenses and service charges: Terms of Sale - Net Payment /Fifteen(15) Days

In Consideration of Each or every extension of Credit by UBX Mailing Service, Inc./UBX Office Supplies,Inc. the undersigned agree(s) that upon account due for services or expenses within fifteen (15) days after receipt of Statement of such account, the amounts due to UBX Mailing Services, Inc. Shall bear interest(designated service charge) at the rate of one and one half percent (1.5%) per month on the unpaid balance thereof from said fifteenth(15th) day after receipt of statement until paid, and that the undersigned shall pay interest (service charges) as aforesaid, in addition to the amounts due on account. I (We), the undersigned, hereby authorize you or any credit reported agency employed by you to investigate the refernces herein. I (We) have read this form thoroughly and accept its conditions. I (We) further state that all information supplied by me (Us) is true in fact and intent.

Yes! I accept the terms of the Authorization/Disclosure/Disclaimer.For Reference please Sign and Fax it to 201-333-7707

 

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