Customer Information / Change Form

Thank you for choosing Taylor Upstate as your restaurant equipment maintenance provider. Please fill out the information requested below. This form is only to be filled out by customers interested in establishing COD terms or using credit card.

"Ship To" Must be Physical Address:

Business Name

Store #

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Store Contact

First Name

Last Name

Main Number

(###)

###

####

Cell Phone

(###)

###

####

Bill To:

Is billing is the same as physical address?

Same as Above

Business Name

Store #

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name

First Name

Last Name

Main Phone

(###)

###

####

Cell Phone

(###)

###

####

A/P Contact

Invoice Delivery

By Mail

By Email

Both

Do You Require A Purchase Order

Yes

Completed By

First Name

Last Name

Any credit card that is kept on file will be automatically charged for all future orders"

Card Number

CSV

Expiration Date

YYYY

Card Holder Name

First Name

Last Name

Address where credit card bill is mailed

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you like the card number put on file?

Yes

Customer COD Terms Application

Customer Information / Change Form

Taylor Upstate

Taylor Upstate Office Locations