EmailMe Form - EmailMeForm Constructions Billing

Company Name *
Please enter the billing-level entity for this form. If you would like us to bill projects as separate entities, we can create individual projects as a sub-customer of the company. You can indicate this below.
Billing Address *

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

Please enter the main office address of the billed-to company.
Project Level Billing

If you want us to bill per project, please list all necessary billing information specific to each project. Note: This will be created as a sub-customer of the parent company.
Accounting Department Phone *
### - ### - ####
Accounts Payable Email *
Receipts, invoices, and other billing correspondences will be sent to this email address.
CC Email
Please enter any additional email you would like CC'ed on any AP correspondences.
Indicate how you choose to get billed. *
AutoPay
Accounts Payable
Verify invoice, then allow SmartBarrel to charge bank or card
PAYMENT INFORMATION
This section is to be filled out if you would like us to charge your bank or card on your behalf. You can choose a one-time payment or recurring payments on the corresponding payment authorization form.
ACH Information

Bank Name

Account Number

ACH Routing Number

Please enter this information only if you authorize us to initiate ACH payments against invoices. A payment authorization form must be executed in order to do so.
Credit Card

Card Number

Please enter this information only if you authorize us to initiate credit card charges against invoices. A payment authorization form must be executed in order to do so.

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SIGNATORY INFORMATION
Please sign and date this form.
I understand that the information in this form will be utilized for the billing functions of SmartBarrel, inc. I attest that I am authorized by the company I represent to provide the information requested in this form. I also understand that any payment information will be discarded if a payment authorization agreement is not enjoined with this submission. If any information in this form is incorrect and results in late payment, I understand that invoices addressed to my company may be assessed late fees. *
Agree
Disagree
Date Time
MM / DD / YYYY
Signature *
Clear

Bank Name
Account Number
ACH Routing Number

PAYMENT INFORMATION

SIGNATORY INFORMATION