Please print and complete this form...

After completing please fax to 952-882-2999

                                  Corporate Account Application 

Company Name:  _________________________________________________________________ 


Contact Person: ________________________________________________________________ 


Address: _________________________________________________________________________ 


City: ________________    State: _______    Zip: ______________ 


Business Phone: _________________________ext. ______________ 

Fax: __________________________________E-Mail_____________________________________ 

*If billing address is different from above please list location and to whom: 

__________________________________________________________________________________ 

Persons authorized to request service: 

1._____________________________________________Title: ____________________________ 

2. ____________________________________________Title:____________________________ 

3. ____________________________________________Title:____________________________ 

Major Credit Card required for securing payments: 


Type: ________________________________________    Number: ________________________ 



Exp. ____/____/___ 

Card Holder Name: _______________________________________________________________ 


Card Holders Signature: __________________________________________________________ 


Type: ___________________________   Number: ___________________ Exp. ___/____/___ 


Card Holder Name: _____________________________________ 


Card Holders Signature: _________________________________ 


Once account is approved it will remain valid  one year of date
unless otherwise cancelled by either party in writing.
I have read and understand the billing terms and the Cancellation Policy 
of this agreement.

Please process my application.      Initial__________ 



Signature ______________________________________________________