Customer/Company Name:* Email* Phone Number*Name of Bank* Account Type*CheckingSavingsRouting Number* Account Number* Bill My Account Once for the Following Amount*Order Verification Number* Signature* By adding a signature, the applicant agrees that all information provided is accurate and complete. The applicant also acknowledges that all orders may be immediately terminated at FDS Distributors' discretion if any charges are declined or chargebacks are claimed against any outstanding invoiced amount. Disputes to amounts invoiced should immediately be reported to Billing@TrexFencingFDS.com. Changes in the status of this account can also be reported to Sales@TrexFencingFDS.com or to your personal Sales Representative. The above signed is an authorized representative of the account stated above. NameThis field is for validation purposes and should be left unchanged.