New Customer Setup

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New Customer Setup Form

1306 Harmon Avenue
Columbus, Ohio 43223

PHONE: 614-272-1800
EMAIL: [email protected]

BUSINESS INFORMATION

Business Name*

Address*

City*

State*

Zip*

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Address

Street Address Address Line 2 City State ZIP Code

Telephone*

ACCOUNT CONTACT INFORMATION

Contact Name*

Title*

Telephone*

Email*

BILLING INFORMATION

Billing Contact*

Address*

City*

State

Zip*

Hidden

Address

Street Address Address Line 2 City State ZIP Code

Telephone*

Email*

Billing Term*

NET 30

COD

Tax Exempt No

Exemption Form*

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Max. file size: 64 MB.

Please Attach Exemption Form

P.O. # Required*

Yes

You hereby agree that you are authorized to set up this account on your companies’ behalf. Any services performed by Capital Towing & Recovery must be paid for in accordance with the terms set forth above.

Name*

Title*

Date*

Comments

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Need Help Now? Call (614) 272-1800

New Customer Setup

New Customer Setup Form

BUSINESS INFORMATION

ACCOUNT CONTACT INFORMATION

BILLING INFORMATION

Let's get you home

Mon	Open 24 Hours
Tues	Open 24 Hours
Wed	Open 24 Hours
Thurs	Open 24 Hours
Fri	Open 24 Hours
Sat	Open 24 Hours
Sun	Open 24 Hours