Customer Onboarding Form – DTE

Company Name *

Contact Name *

First

Last

Billing Contact Phone *

Bill To Address *

Address Line 1

Address Line 2

City

State

Zip Code

Ship To Address: (If different than Bill To address) *

Address Line 1

Address Line 2

City

State

Zip Code

Customer Email Address: *

Document Routing Instructions *

Customer Can Receive Invoices And Sales Orders Direct From ActivePure
Send All Invoices and Sales Orders To Me, I Will Route To Customer
Other (specify below)

Select how this customer should receive copies of sales orders, invoices and statements.

Line of Credit

No
Yes

Do you wish to setup a credit line greater than $10k for this client?

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