CID: __2618__
CORP: _________
ACCT CODE: _________
Online Training - Corporate Billing Account Application
I request an Online SchoolRoom business account authorization code for online training courses. I understand that completion of this application will result in my company/organization receiving an authorization code that my employees can use to access training courses via a computer with modem/Internet access anytime anywhere.
After processing this application, Online SchoolRoom will issue my company an authorization code. I understand that it is my responsibility to inform current/prospective employees of this code and that I am responsible for payment of all courses taken by trainees via this code. Invoices/Payment will be processed by 360training.com.
Please type/print the following information. Allow 5 days for processing. Authorization codes will only be given to the contact person listed on this form and is subject to change.
SALES REPRESENTATIVE: _________________________________________________
SALES REPRESENTATIVE: _________________________________________________COMPANY NAME: ______________________________________________________
COMPANY NAME: ______________________________________________________ CHECK TYPE OF BUSINESS: 0 Sole Proprietorship0 Corporation 0 Government
CHECK TYPE OF BUSINESS: 0 Sole Proprietorship0 Corporation 0 Government- Federal Employer Identification No. or Local State Taxpayer:
PAYMENT METHOD OPTIONS (Check One):
PAYMENT METHOD OPTIONS (Check One):0 Credit Card: (Your credit card will be charged within 5 business days of the following month)
(Your credit card will be charged within 5 business days of the following month)Type:Please Select
Please Select Number:
Exp. Date (mm/yy): /
/ Name on Card: ___________________________________________________________________
0Purchase Order (Statements sent 10th of each month; payment due net 10)
Purchase Order (Statements sent 10th of each month; payment due net 10) P.O. Number:
CONTACT INFORMATION
CONTACT INFORMATION- Contact Person _________________________________________
- Mailing Address: ________________________________________
- City/State/ZIP: _________________________________________
- Tel:( ) -
( ) - - Fax:( ) -
( ) - - E-Mail:
PURCHASE ORDER BILLING INFORMATION
PURCHASE ORDER BILLING INFORMATION- Contact PersonPlease Select
Please Select - Mailing Address:
- City/State/ZIP: / /
/ / - Fax:( ) -
( ) - - Contact Persons Signature:____________________________________________________
Please Email and/or Fax this form to support@classroom-on-line.com Fax 888.742.6518
If you need assistance in any way, please call Nash or Ken at 877.230.9485
Food Safety
Corporate
Billing Form
