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Kiwi Coders Corporation accepts terms of Net 30 days, checks, Visa, MasterCard, Discover Card and American Express.

On behalf of the entire Kiwi Coders Corp. staff, I’d like to take this opportunity to welcome you as a new customer. We are thrilled to have you with us.

At Kiwi Coders, we pride ourselves on offering our customers responsive, competent and excellent service. Our customers are the most important part of our business. Please fill out the attached documents at your earliest convenience and return to info@kiwicoders.com.

General Business Information

Business Name:

DBA:

Street Address:

City:

State:

Zip:

Phone:

Fax:

Years in Business:

Federal Tax ID #:

Dun & Bradstreet ID #

Tax Exempt: (If Yesinclude Copy)

Yes No

Attach Document

Name of Owners, Partners, or Officers

Name of Owner:

Title of Owner:

Phone of Owner:

Email of Owner:

Name of Partner:

Title of Partner:

Phone of Partner:

Email of Partner:

Name of Officers:

Title of Officers:

Phone of Officers:

Email of Officers:

Trade References

Name:

Address:

City:

State:

Zip:

Phone:

Fax:

Bank Reference

Bank Name:

Contact Name:

Account #:

Address:

City:

Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Billing Information:

Prefer to have invoices:

Emailed Mailed

Address:

City:

State:

Zip:

AP Contact:

AP Email:

TERMS:

In consideration of Kiwi Coders extending credit to the Applicant, the Applicant agrees to pay for all items delivered or services rendered to the Applicant in accordance with the terms of each invoice. Applicant agrees to each of the terms and conditions of sale from Kiwi Coders to the Applicant. Should it become necessary to place the account with a collection agency or attorney, the applicant agrees to pay all collection and attorney fees in addition to all other sums due.

Applicant authorizes Kiwi Coders to obtain credit and financial information concerning the Applicant at any time and from any source. The undersigned warrants that the above agreement has been carefully read and that Applicant understands it completely.

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Date:

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General Business Information

Name of Owners, Partners, or Officers

Trade References

Bank Reference

Billing Information:

TERMS:

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