Towing Information Exchange Service
New Customer Information Sheet
Company:
__________________________________________________________________
Name: ______________________________________________________________________
Address: ____________________________________________________________________
Billing Address: ______________________________________________________________
City:
Phone: ______________________ Cell: ___________________
Pager: _________________
Fax: ______________________________ E-Mail:
__________________________________
Type of Service: 
Membership Web
Hosting E-Mail
Server
Banner Ad Domain
Registration Web Development
Network Setup/Server
Computer Service
Internet Setup/Training
Other Services Explain: ___________________________________________
Notes: 
____________________________________________________________________________
One Time Charge: ________________________
Monthly Charge:
________________________
Effective Date: ______________________
Salesman: ______________________________________________
Date:________________
Customer: ______________________________________________
Date:________________
