LibertyToner.com / Net 30 Authorization Agreement

Net 30 Payment Terms Agreement

Please print out this form, fill out completely, and Fax toALX Imaging, LLC at (210) 651-6130


Billing Information:
Company/Name: Phone Number:
Address: City/State:
Suite/Rm/Floor: Postal Code:
Attn Contact: A/P Fax Number:

Select Here:    Corporation, Date Inc.______, State Inc.___  Partnership  Proprietorship  L.L.C  Non-Profit


Shipping Information:
Company/Name: ShipTo Attn:
Address: Estimated Monthly Purchases:
Suite/Rm/Floor: Multiple Shipping Locations:        YES  NO
City/State/Zip: Is a Purchase Order Required?    YES  NO

Credit Card Information:
[FrontPage Save Results Component]

Please select one:    Visa Visa          MasterCard MasterCard          Discover Discover          Discover AMEX

Credit Card Number: Expiration Date:
Name(s) on Credit Card: 3 Digit CVV Code:
C/C Billing Address: Zip Code:
C/C City/State: Tel No:

Terms & Conditions of Sale: (Please read and understand before signing)

  • I, the undersigned,  agree to pay for all purchases according to the terms & conditions as they appear on the most current web site at ALX Imaging, LLC. If credit is extended, I/we agree to pay all debts incurred within the terms of sale. The undersigned agrees to the continued solvency of the Credit Card as a precondition to any sales made by ALX Imaging, LLC. No terms or conditions of purchase orders different from the terms of ALX Imaging, LLC will become part of the Sales Agreement. However, if the debt should become past due. I/we expressly agree to give ALX Imaging, LLC permission to apply the full remaining balance, plus 7% of said balance (to cover credit card and other processing fees), as well as any current or future purchases, to the beforementioned Credit Card. I/we also agree to authorize ALX Imaging, LLC to verify the validity of the beforementioned Credit Card from time to time.
  • The laws of the State of Texas shall be applicable to all suits arising under any agreement between the undersigned andALX Imaging, LLC. In the event of litigation, venue shall be the choice of ALX Imaging, LLC. I/we further agree to pay reasonable collection costs and attorney's fees incurred by ALX Imaging, LLC to collect any outstanding balances.
  • I understand that, with my signature, I acknowledge that I have checked all information provided to ALX Imaging, LLC and it is correct, and that I have read, understand and agree to all the terms and conditions, and a minimum annual volume requirement is $12,000 net sales.

Cardholder Signature: Date:

Copyright © 2011/2013  ALX Imaging, LLC ~ 4080 Linne Road ~ Seguin, TX 78155
(210) 651-5000