Corporate Office: 1905 Premier Row, Orlando FL 32809
Ft Lauderdale - Ft Myers - Jacksonville - Orlando - Savannah - Tampa - Charleston
Ph: 407-888-8008 or 888-233-2745 Fax: 407-888-9092

Payment Agreement

Property name*

Property Name/Company Name/GC Name

Street address*

City*

State/Region*

Postal code*

Phone number*

Billing Name*

If different than Property/Customer Name

Billing Address *

Federal Employee Identification Number (FEIN):*

Management Company*

Management Company Address*

Management Company Phone Number*

Property Manager*

Property Manager Email*

Property Manager Direct Phone Number*

Regional Manager*

Regional Manager Email*

Regional Manager Phone Number*

Contact name for payment questions*

Email address for AP contact*

Phone Number for AP Contact*

Do you require any vendor programs for document tracking?*

Do you require any vendor programs for electronic invoicing?*

I agree

Please provide a sample Certificate of Insurance (COI) if there are special requirements on a separate sheet.
Payment terms are Net 30.

Payments not received based on the agreed-upon terms may be subject to 1.5% interest per month on any outstanding balance. In the event that The Carpet Company 3 Inc DBA Southeast Floors is required to use the services of an attorney for collection, reasonably incurred attorney's fees will be assessed.

Note: As a standard practice, we file a Notice to Owner within 45 days of initial installation. This is not a lien. It simply states that The Carpet Company 3 Inc DBA Southeast Floors has supplied services and materials on your property.

Applicant's signature attests ability and willingness to pay invoices in accordance with the terms of Net 30 days.

The above information is for the purpose of establishing credit account and is warranted to be true. Each party agrees that electronic signatures have the same force and effect as manual signatures. *

First name*

Last name*

Job title*

Todays Date*

Month/Day/Year

Select Your Account Manager