Advanced Network Systems Customer Profile Update

Shipping Address

Company Name*      
Street Address:      
City:      
State:      
Zip:      
Phone: Fax:  
Primary Contact: Email: Copy on invoices?
Secondary Contact: Email: Copy on invoices?

Accounts Payable Information:

Company Name*:
Street Address:
City:
State:
Zip:
 
Phone for AP Inquiries:
 Fax for invoicing:
Primary AP Contact:
 Email for invoicing:
E-mail Address for AP Correspondence if differentfrom above:
Tax ID Number:
 Tax Exempt ID Number:
I certify to the best of my knowledge that the information on this form is correct and authorize Advanced Network Systems to deliver invoices and statements via email in PDF format or via facsimile using the information provided above.
Your Name:*
 Title*: