Lou Negley's Bottled Water Service

Lou Negley's Bottled Water, Inc.

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106 Corks Ln, Butler, PA 16001

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Lou Negley Business Form

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Residential Account Setup Form

Date

Salesperson

Account #

New Field:

NEW ACCOUNT

UPDATE

RENAME

ADD SHIP TO

*PARTNERSHIP

Free Text

Credit Information

Business Name

Contact

Billing Address

Cell#

Fax #

Type of Business

Home #

*Owner/Partner Name

E-mail

How long in Business?

Tax ID#

Number of Employee?

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Billing Information

New Field:

OPEN ACCOUNT

CREDIT CARD

ONE TIME ONLY

INVOICE BY E-MAIL

Purchase Order / Job # / CC#

E-mail

Tax Exempt # (attach copy)

How did you hear of us

Ship to #1

WATER

COFFEE

Name

Contact

Street

Phone

Department

Cell

Floor/Room #

E-mail

City

State/Zip

Ship to #2

WATER

COFFEE

Name

Contact

Street

Phone

Department

Cell

Floor/Room #

E-mail

City

State/Zip

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Route Type

Free Text

Monthly Route

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New Field:

New Field:

Free Text

Bi-Weekly Route

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New Field:

New Field:

Free Text

Will Call

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New Field:

New Field:

Free Text

Rental Only

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New Field:

New Field:

Free Text

Special

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New Field:

New Field:

Free Text

Product Type

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New Field:

New Field:

New Field:

New Field:

New Field:

Free Text

Quantity

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New Field:

New Field:

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Free Text

Price

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Free Text

Price Protected Term Date

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Free Text

Amount

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New Field:

New Field:

New Field:

New Field:

Subtotal without Applicable State Taxes

CUSTOMER SIGNATURE

Date

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Denied

Reviewed By

DATE

Thank you for contacting us.
We will get back to you as soon as possible.

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Business Account Setup Form

Date

Salesperson

Account #

New Field:

NEW ACCOUNT

UPDATE

RENAME

ADD SHIP TO

*PARTNERSHIP

Free Text

Credit Information

Business Name

Contact

Billing Address

Cell#

Fax #

Type of Business

Home #

*Owner/Partner Name

E-mail

How long in Business?

Tax ID#

Number of Employee?

Free Text

Billing Information

New Field:

OPEN ACCOUNT

CREDIT CARD

ONE TIME ONLY

INVOICE BY E-MAIL

Purchase Order / Job # / CC#

E-mail

Tax Exempt # (attach copy)

How did you hear of us

Ship to #1

WATER

COFFEE

Name

Contact

Street

Phone

Department

Cell

Floor/Room #

E-mail

City

State/Zip

Ship to #2

WATER

COFFEE

Name

Contact

Street

Phone

Department

Cell

Floor/Room #

E-mail

City

State/Zip

Free Text

Route Type

Free Text

Days Open

Free Text

Hours

Free Text

Special Instructions

Free Text

Monthly Route

New Field:

New Field:

New Field:

Free Text

Bi-Weekly Route

New Field:

New Field:

New Field:

Free Text

Will Call

New Field:

New Field:

New Field:

Free Text

Rental Only

New Field:

New Field:

New Field:

Free Text

Special

New Field:

New Field:

New Field:

Free Text

Product Type

Free Text

Quantity

Free Text

Price

Free Text

Price Protected Term Date

Free Text

Amount

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

New Field:

Subtotal without Applicable State Taxes

CUSTOMER SIGNATURE

Date

New Field:

Approved

Denied

Reviewed By

DATE

Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
Please try again later.

CONTACT INFORMATION

Address: 106 Corks Ln, Butler, PA 16001
Phone: 724-282-6160

Mon-Fri	08:30 AM - 04:30 PM
Sat-Sun	Closed

OUR LOCATION

BROWSE OUR WEBSITE

Home
Water & Coolers
Water Treatment & Filtration
Salts
Contact
Forms

CONTACT INFORMATION

Address: 106 Corks Ln, Butler, PA 16001

Phone: 724-282-6160

Mon-Fri	08:30 AM - 04:00 PM
Sat-Sun	Closed

OUR LOCATION

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