New Account Setup Form

300 – New Customer Setup Form

Billing Information

Billing Contact Name
Billing Contact Name
First
Last
Type of Account
RECURRING ACH PAYMENT AUTHORIZATION

You authorize regularly scheduled charges to your account. You will be charged the total amount due from the invoices received from Santiam Ice Company for deliveries from your checking account for each billing period. A receipt for each payment will be provided to you, and the charge will appear on your banking statement. You agree that no prior notification will be provided.

Type of Bank Account *

Maximum file size: 516MB

Name
Name
First
Last
I  understand that this authorization will remain in effect until I cancel it in writing. I agree to notify the Merchant in writing of any changes in my account information or termination of this authorization at least fifteen (15) days before the next billing date. If the above-noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I certify that I am an authorized user of this account and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.

Delivery Locations

Do you need a merchandiser?
Type of Ice

Maximum file size: 516MB

Maximum file size: 516MB

Please send all mail and checks to: PO Box 610 Detroit Oregon 97342

Email us at [email protected]

If have any questions call us and we will help you with setting up a new account 503-679-2422