Toyota Material Handling Ohio Cash Customer Set-Up
COMPANY INFORMATION
Bill To:
*
Street:
*
City:
*
State:
*
Zip Code:
*
Phone Number:
*
Ship To:
Street:
City:
State:
Zip Code:
Phone Number:
Federal ID #:
*
Tax-Exempt:
*
Yes
No
If your company is tax-exempt, a certificate(s) must be returned with this information. If a complete tax exemption certificate is not received, Toyota Material Handling Ohio MUST charge sales tax on your invoices.
File Upload (Tax-Exempts, Credit sheets, Etc.)
Credit Card Authorization
BUSINESS INFORMATION (Select all that apply)
Business Entity
Public Entity
Private Entity
Business Information
Corporation
Partnership
Proprietorship
Other
Business Information
Corporation
Partnership
proprietorship
Other
Business Entity
Public Entity
Private Entity
Business Information
Corporation
Partnership
Proprietorship
Other
Business Information
Corporation
Partnership
Proprietorship
Other
Parent Company Name (If applicable)
DUNS Number
Years in Business
Credit Card Charge
One Time Charge
Recurring Charge
Please complete the information below:
Name:
I, (authorized AP Personnel) authorize Toyota Material Handling Ohio to process a recurring/one time charge for
$ Charge:
on the day service is rendered.
*Please note - all payments made by credit card that are over $5,000.00 are subject to a 3% processing fee.
This payment is for
Goods/Services:
(Description of goods/services)
Billing Address
Address:
*
City:
*
State:
*
Zip:
*
Email:
*
Phone Number:
*
Account Type:
Visa
MasterCard
American Express
Discover
Cardholder Name:
*
Account Number:
*
Expiration Date:
*
CVV2 (3 digit number on back of Visa/MC/Discover):
*
Signature:
*
Date:
*
I authorize the above named business to charge the credit card indicated on this authorization form according to the terms outlined above. This payment authorization is for the amount indicated for the amount above only. I certify that I am an authorized user of this card and that I will not dispute the payment with my credit card company so long as the transaction corresponds to the terms indicated above. I understand that this authorization does not grant permission to charge my card for any additional goods/services.