New Client Credit Profile

Please email the completed profile along with Certificate of Insurance requirements to

Work Site Information / Billing Information
Name: / Billing information is same as site information
Site POC: / Name:
Address: / Billing POC:
City, State, Zip: / Address:
Email: / City, State, Zip:
Phone: / Email:
Phone:

Is this business tax-exempt*? Yes No

*If yes, please return your tax exemption certificate with this form

Would you like us to request a PO from your company when a call is placed? Yes No

How long has your company been in business? D&B Number?

What is the reason for your service call?

Contact information for Partners/Corporate Officers (CEO, President, CFO, COO, etc.)
Name: / Name:
Title: / Title:
Email: / Email:
Phone: / Phone:
Credit Card Information
Would you like to set up auto-pay on your account? YesNo If yes, your invoices will automatically be charged to the credit card listed below.
Credit Card Type: American Express Visa Master Card
Credit Card Number:
Expiration Date:
Security Pin:
Billing Zip Code:
Bank Reference
Bank Name: / Account Number:
Bank Contact: / Phone number:
Contact Information for the Person(s) Responsible for Approving Invoices and Accounts Payable
Name: / Name:
Title: / Title:
Email: / Email:
Phone: / Phone:
Please email invoices to:
Please email my account statement to:
Building Information
Building Management Company: / Building Manager Phone:
Building Manager Name: / Building Manager Email:
New Customer Billing Rate Details
The undersigned hereby unconditionally agrees to the following new customer billing terms and conditions.
  • Everycall, no matter what the reason, with the exception to contract surveys, will be billed at 2-hour minimum at $180.00/regular time hour/technician, Collect on Delivery (COD), plus a $45.00 trip charge. The customer’s credit card will automatically be charged the time the technician spent on the call (with a minimum of 2-hours) upon completion of the call by the technician.
  • Overtime (Monday – Friday, 4:30-PM – 8:00AM, Saturday, all day) will be charged at $270.00/hour/technician (4-hour minimum).
  • Double time (Sunday and Holidays) will be charged at $360.00/hour/technician (8-hour minimum).
  • Contract surveys are free of charge, however if the technician performs any troubleshooting, repair or non-contract survey work while onsite, the customer will be charged for that time at the appropriate rate per hour.
  • Time spent on non-contract surveys will be credited to the customer only if the customer contracts Kaback to preform the surveyed work.
  • Kaback will not third-party bill.

Print Name:
Signature:
Title:
Date:
Open Account Credit Terms
All Invoices are due 15 days from date of invoice. At the discretion of Kaback Service Inc., any account with a delinquent balance may be placed on a cash basis. Customer agrees to pay all reasonable attorney fees, collection costs, and court costs incurred by Kaback Service, Inc. in enforcing these terms and conditions. Customer agrees to the terms and conditions as stated on each and every Kaback Service, Inc. quote, contract, work ticket or invoice.
Print Name:
Signature:
Title:
Date:
Continuing Personal Guarantee
The undersigned hereby unconditionally guarantee(s) the full and prompt payment to Kaback Service, Inc. when due all indebtness, obligations, and liabilities of the customer named in the New Client Profile, including all amounts now owing and arising in the future, and including any interest, attorney fees, and collection and court cots. The undersigned agrees to be personally bound by all credit terms of this New Client Profile. This guarantee shall continue in force until notice in writing sent by certified mail, return receipt requested, is received by Kaback Service, Inc. This notice shall specify the date of termination, not to be less than fifteen days (15) after the notice and shall not affect any charges for transactions with the customer that were entered into prior tot he termination date.
Print Name:
Signature:
Title:
Date:

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Please email completed client profile along with Certificate of Insurance requirements to