Social Security #:

Expiration Date:

Card Number:

Name on Card:

Payment Notes:

Payment Method:

Freight Tax Code:

Printed Form:

Shipping Method:

Comment:

Salesperson:

Account:

Sales/Purchase Layout:

Custom List 3:

Custom List 2:

Custom List 1:

Custom Field 3:

Custom Field 2:

Custom Field 1:

Picture:

           - DPID:

           - Salutation:

           - Contact Name:

           - WWW:

           - Email:

           - Fax #:

           - Phone # 3:

           - Phone # 2:

           - Phone # 1:

           - Country:

           - ZIP Code:

           - State:

           - City:

           - Line 4:

           - Line 3:

           - Line 2:

Addr 5 - Line 1:

           - DPID:

           - Salutation:

           - Contact Name:

           - WWW:

           - Email:

           - Fax #:

           - Phone # 3:

           - Phone # 2:

           - Phone # 1:

           - Country:

           - ZIP Code:

           - State:

           - City:

           - Line 4:

           - Line 3:

           - Line 2:

Addr 4 - Line 1:

           - DPID:

           - Salutation:

           - Contact Name:

           - WWW:

           - Email:

           - Fax #:

           - Phone # 3:

           - Phone # 2:

           - Phone # 1:

           - Country:

           - ZIP Code:

           - State:

           - City:

           - Line 4:

           - Line 3:

           - Line 2:

Addr 3 - Line 1:

           - DPID:

           - Salutation:

           - Contact Name:

           - WWW:

           - Email:

           - Fax #:

           - Phone # 3:

           - Phone # 2:

           - Phone # 1:

           - Country:

           - DPID:

           - WWW:

           - Email:

           - Phone # 3:

           - Country:

Card Status:

Card ID:

           - 1099:

Volume Discount %:

A.B.N. Branch:

A.B.N. :

Tax ID No.:

Credit Limit:

Use Vendor's Tax Code:

Use Customer's Tax Code:

Tax Code:

           - % Monthly Charge:

           - % Discount:

           - Balance Due Days:

           - Discount Days:

Terms - Payment is Due:

Price Level:

Cost Per Hour:

Billing Rate:

Currency Code:

Notes:

           - Contact Name:

           - Salutation:

Identifiers:

           - Fax #:

           - Phone # 2:

           - Phone # 1:

           - ZIP Code:

           - State:

           - City:

           - Line 4:

           - Line 3:

           - Line 2:

Addr 2 - Line 1:

           - ZIP Code:

           - State:

           - City:

           - Line 4:

           - Line 3:

           - Line 2:

Addr 1 - Line 1:

First Name:

Co./Last Name: