2012-08-07_PR_Packet - Laserfiche WebLink

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ATTACHMENT B RESPONDENT PROFILE FORM Purchase Orders should be faxed to: Firm Name: Contact Person: Title Street: City, State, Zip: Phone: Fax: Web Address: E-Mail Address: Payments should be mailed to: Firm Name: Contact Person: Title: Street: City, State, Zip: Phone: Fax: Do you accept Master Card? Yes: Payment Terms: Net 30 No: Federal Tax I D#or MN State Tax I D#: Social Security#: Signature of Date: Authorized Agent: Page 32 of 40