Net 30 Payment Terms Agreement

Please print out this form, fill out completely, and Fax to NewproNet Corp. at (210) 651-6130
Billing Information:
Company Name: A/P Contact:
Address: A/P Phone Number:
Suite/Rm/Floor: A/P Fax Number:
City/State/Zip: Email:
Phone Number: Number of Employees:

Check One:  Corporation,   Date Inc. ______,  State Inc.______   Partnership   Proprietorship  L.L.C.  Non-Profit
 
Shipping Information:
Name: Ship Attn:
Address: Estimated Monthly Purchases:
Suite/Rm/Floor: Purchasing Agent:
City/State/Zip:

Is Purchase Order Required?    YES  NO
 
Secured Credit / Credit Card Information:

Please select one:    Visa Visa         MasterCard MasterCard         Discover Discover
Credit Card Number: Expiration Date:
Name(s) on Credit Card:
Credit Card Billing Address:
 
Terms & Conditions of Sale: (Please read and understand before signing)
I/we the undersigned,  agree to pay for all purchases according to the terms & conditions as they appear on the most current NewproNet Corporation (NEWPRO) web site (www.newprolaser.com). If credit is extended, I/we agree to pay all debts incurred within the terms of sale. The undersigned agrees to the continued solvency of the undersigned credit card as a precondition of any sales made by NewproNet Corporation. No terms or conditions of purchase orders different from the terms of NewproNet Corporation will become part of the Sales Agreement. However, if the debt should become past due, I/we expressly agree to give NewproNet Corporation (NEWPRO) permission to apply the full remaining balance, plus 7% of said balance (to cover the additional credit card and other processing fees), as well as any current & future purchases, to the below mentioned Credit Card. I/we agree to authorize NewproNet Corporation to verify the validity of the undersigned credit card from time to time.
The laws of the State of Texas shall be applicable to all suits arising under any agreement between the undersigned and NewproNet Corporation. In the event of litigation, venue shall be the choice of NewproNet Corporation. I/we further agree to pay reasonable collection costs and attorney's fees incurred by NewproNet Corporation to collect any outstanding balances.
I understand that, with my signature, I acknowledge that I have checked all information provided to NewproNet Corp and it is correct.
Cardholder Signature: Date:

NewproNet Corporation / Laser Products ~ 9330 Corporate Drive, Suite 603 ~ Selma, TX 78154-1255 ~ (210) 651-5000 ~ Fax (210) 651-6130