EmailMe Form - Vendor Prepayment Request

Vendor Information

Vendor Name

Vendor Phone

### - ### - ####

Vendor Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Vendor Contact Name

First Last

Vendor's Order Number

Is this Prepayment for postage?

Yes

No

POSTAGE PREPAYMENT? - If this is for a Postage Prepayment, Postage needs to be invoiced to YOUR CLIENT AT THE TIME OF PREPAYMENT TO YOUR MAILING VENDOR. Please make sure you have a separate line item in your Purchase Order for postage.

Postage Pay to the order of:

Customer Information

Customer Name

Quantum Customer ID

Is this client currently insured?

Yes

No

Purchase Order Information

In order to proceed with the order, the vendor has requested prepayment toward the cost in the amount of:

Pre-payment Amount Requested $$ *

Please note that no more than 50% of your total cost of goods will be pre-paid in advance of production. This policy will ensure your product is produced correctly and meets your specifications.

IMPORTANT INFORMATION:
For any sale that is greater than $10,000.00 you will need to insure your client. Fill out the Bad Debt Insurance Request Form Insurance requests can take from 24-48 hours to get confirmation back if your client is insurable.

I anticipate the total cost to be approximately $ *

Purchase Order Number *

Estimated Ship Date *

Requested Method of Payment

Vendor Invoice Upload

Upload your vendor's prepay forms or vendors invoice if you have it.

Payment must be received by date:

Notes to Ampersand:

Member Information

Any cost of special delivery (i.e.: overnight check) will be charged to the cost of the order.

I understand and agree that by submitting this document as a member of The Ampersand Group and under the terms of my service agreement I will be held financially responsible for the amount of this prepayment and any additional costs incurred in the event of nonpayment by the customer.

Member ID: *

Date Time

MM / DD / YYYY

Member Email Address *

I can be reached at (Phone Number) for any questions:

### - ### - ####

Instructions

Your Purchase Order must be created in the system before completing this form.

No prepayment will be made if Purchase Order is not in the system.

To Print

Choose File > Print to print a copy of this form before you submit.