Page 27 - Sample

Basic HTML Version

National
Electrical
Price Guide On Line
Order Form
Service Agreement
Please enter our subscription for
the National Electrical Price Guide
On Line as indicated above and published by
Electrical Resources, Inc. (ERI), in accordance with the terms and conditions stated below.
We understand that the subscription fees are payable annually or monthly and shall be continuous until service is
canceled by written notice from my company or ERI.
It is understood that ERI will endeavor to compile and publish accurate price and labor information, but we agree that
the information you provide cannot be guaranteed.
We understand that the
NEPG
On Line and its contents will be for our use only.
We understand that the subscription fee is subject to change.
Internal Use Only
Product Code:______________________________
Account Number:___________________________
Date Shipped:_ _____________________________
Check Number:_____________________________
First Generation:____________________________
NEPG On Line
$495 Annual Subscription
TM
Please Return Entire Service Agreement • You May Wish To Make A Copy For Your Records
2323 S. Washington Avenue, Suite 200
Titusville, Florida 32780
1-800-766-1045 • Fax 321-385-3095
www.electricalresources.com
NEPG
On Line
NEPG On Line
$41.25 Montnly Subscription
For
Company Name
_ _____________________________________________________________________________
Billing Address
_ ______________________________________________________________________________
Department/Mail Stop_ ________________________________________________________________________
City_______________________________ State_ _______________________ Zip_______________________
Telephone
_ __________________________________
Fax
_ __________________________________________
Cell Phone
___________________________________
E-Mail
_________________________________________
Contact_ ____________________________________________________________________________________
Signature
_ _____________________________________________
Date_ _______________________________
Payment
ACH (Check)
Florida Residents Must Add 6% Sales Tax
Total Users
_________________________________
Total Due
______________________________________
Card # or Account #_ _____________ _________________________________ Security Code_ _____________
Credit Card Expiration Date or Checking Account Routing #_ ________________________________________
Name on Credit Card or Account________________________________________________________________
Billing Statement Address_________________________________________ _____________________________
City_______________________________ State_ _______________________ Zip_______________________
Signature of Cardholder
_ ______________________________________________________________________