NEW CUSTOMER ACCOUNT – Exacta Messenger Services

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NEW ACCOUNTS – COMPLETE APPLICATION

Please complete the application and one of our expert customer service representatives will contact you shortly to set up your account during normal business hours.

NEW CLIENTS: SPECIAL 25% DISCOUNT OFF YOUR FIRST DELIVERY!

Name:*

Title:

Phone:*

Ext

Email:*

Best time to be reached:

Company:*

Street Address:*

Suite:

City:*

State*:

Zip:*

Fax:

Website:

Billing Information, if different from above.

A/P Contact

Street Address:

Suite:

City:

State:

Zip:

Require Billing References?
YesNo

HOW DID YOU HEAR ABOUT US?
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Referral

Other

The above is true and submitted for the purpose of opening an account with Exacta Messenger Services. This will authorize Exacta Messenger to verify the above information. This account will be billed biweekly, with Net 15 payment terms. I further state that I have the authority to submit this application on behalf of my company.