InterPlex Transportation - DIRECT BILL APPLICATION
Account Information
Company Name
Contact
Title
Department
Main Phone
ext:
Direct (or Cell) Phone
Fax
e-mail address
Web Site
Business Address
Street
City
State
ZIP
Country
Billing Adress
(if different)
Street
City
State
ZIP
Country
Attn:
Department:
Please include me on your email list
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Credit Card Information
Credit Card Type
-Please Select-
AmEx
Visa
MasterCard
Discover
Card #
Expiration Date :
MM /
YYYY
Cardholder Name :
TERMS:
InterPlex invoices are due upon receipt. Interest to be added to all past due bills at the rate of 1.5% per month. In case of errors or questions about your invoice, we must hear from you in writing no later than 30 days after you receive the invoice on which the problem appeared. You do not have to pay any amount in question while we are investigating, but you are still obliged to pay the parts of your outstanding balance that are not in question. In the event that you become delinquent or default in the payment of any amounts due and owing InterPlex Transportation over 60 days, InterPlex Transportation will place your account on credit hold and charge your credit card on file for the balance of your account including any finance charges. InterPlex Transportation also has the right to initiate collection proceedings on delinquent accounts and any attorneys' fees, collection, and court costs. InterPlex Transportation reserves the right to convert the account to a credit card only status. By signing below you agree to the above terms. You also give InterPlex Transportation the authority to get financial information on the balance of the above listed reference accounts. If a corporation, the signed must be an officer or a person who is legally able to bind the company.
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