NEW ACCOUNTS: The following information is required prior to or with the first case you submit to our Laboratory. Missing information may cause a delay in shipment.
EXISTING ACCOUNTS: Please complete only the information to be changed.
Existing customer New customer
Unless advised otherwise, we will keep the following information on file for future payments.
I request that fees owed to the Winter Laboratory be charged to the credit/debit card above. I understand that if I cancel an order after work has begun, I am responsible for those charges, as well as any charges rejected by my credit card company.
Please indicate your payment option, type your name in the "Signature of Cardholder" box, and submit this form to the Winter Laboratory. A copy of each invoice will be sent with each case. A monthly statement of account activity (invoices and payments) will be sent at the beginning of each month for the prior month's activity. Please note that a 2% penalty per month will apply on any outstanding balances more than 30 days from the first statement date on which the charge appears. Accounts with past-due amounts may be placed on C.O.D. status.
Please contact Accounting with any questions.
Phone: (949) 265-2675 • Fax: (949) 315-3860 • Email: firstname.lastname@example.org