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Marktec Products, Inc.
653 Ellicott Street
Batavia, NY 14020
Tel: 800-627-5832
FAX: 585-344-4109
Dear Customer,
In order to process a credit card order we will need the following information. We
ask that you complete this credit card application form and return it to us via fax at
585-344-4109 or mail it to the above address. Once we have received this form, we
will set up a credit card account to process your orders.
Address to Mail Receipt to:____________________________________________
Ship to Address:
Telephone Number: ___________________________________________
Contact Person: _________________________ Extn: ________
Contact E-mail Address: ________________________________________
Please specify which method you would like to receive your receipt for charge card
E-Mail ____
E-Mail Address: ______________________________
Fax ____
Fax Number: ________________________________
Mail ____
Tax Exempt:
Tax Exempt Number: ____________________
If Tax Exempt, please fax a signed Tax Exempt certificate for our records. It is the
responsibility of the purchaser to pay all sales and use taxes directly to their state
and local governments for all shipments outside of New York and Pennsylvania.
All UPS Freight charges from Factory will be prepaid and added to invoice unless you
specify a freight collect account number below.
Freight Collect:
UPS Account Number:___________________________
Thank you for your assistance,
Ms. Terry Read ([email protected])
Credit Supervisor