1306 Harmon Ave Columbus OH 43223 327 N Main St Marysville OH 43040 680 S Nelson Rd Columbus OH 43205

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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*

Street Address Address Line 2 City State ZIP Code

Telephone*

ACCOUNT CONTACT INFORMATION

Contact Name*

Title*

Telephone*

Email*

BILLING INFORMATION

Billing Contact*

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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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.

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USDOT 1913247 | PUCO 156841-T

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