Customer Accounts Payable Form

Customer Information
Customer*
Main Telephone*
Bill To*
Street Address Address Line 2 City State ZIP Code
Accounts Payable Contact Information
Accounts Payable Contact*
First Last
Accounts Payable Contact Email*
Accounts Payable Email (if different)
Accounts Payable Telephone*
Accounts Payable Fax
Tax Exempt*
- Yes
- No
If yes, please email a copy of your tax exempt certificate to AR@TotalScopeInc.com or provide below.
Upload Tax Exempt Certificate
Max. file size: 50 MB.
Customer Terms
Special Payment Terms
GPO Affiliate
If multiple, who is primary?
Primary Method of Billing*
- Email
- Paper
Billing Email
Primary Method of Payment*
- Electronic/ACH
- Credit Card/Purchase Card
- Check
Notes

Customer Information