Corporate Billing
Online SchoolRoom
CORPORATE BILLING ACCOUNT APPLICATION FORM
This application is to request an Online SchoolRoom Corporate Billing Account for online courses. Acceptance of this application allows Online SchoolRoom to invoice __________________ “Client” for course purchases online versus end users providing payment, up to 200 employees, by using an Account Payment Code.
Client understands execution of this application will result in _________________________________ receiving an Account Payment Code or Codes for their employees to use in accessing online training courses via any computer with Internet access.
After approval and processing of this application, Online SchoolRoom will issue the Client a Corporate Account Payment Code. It will be the responsibility of the Client to inform their employees of this code.
360training.com, Inc. (“360”), the entity responsible for processing payments for Online SchoolRoom course services, will invoice Client on the 10th of the month for courses registered using the Corporate Account Payment Code during the prior calendar month. Payment is due upon receipt of the invoice based on student registration(s).
Payment not received within 30 days of the invoice date, will be automatically charged to the credit card of the Client, held on file, for the outstanding balance.
360 will include a monthly report of all students who registered for courses during the previous month with the monthly invoice to the Client.
Please print the following information and allow 5 days for processing of this application from receipt by Online SchoolRoom/360training. Corporate Account Payment Code information will only be given to the contact person listed on this form and is subject to change.
COMPANY NAME: ________________________________________________
CHECK TYPE OF BUSINESS:
Partnership
Sole Proprietorship
Sole ProprietorshipLLCCorporation
CorporationState:
Federal Employer Identification No. or Local State Taxpayer No:__________________________
DUNS Number:______________________________-
CHECK PAYMENT METHOD:
A credit card is required to be on file with Online SchoolRoom/360training, if you select Autopay your credit card will be charged within the first (5) business days of each month. Payment by check or wire transfer is required to be received within 30 days from the invoice date, or the credit card will be charged for the outstanding balance.
oCredit Card
Credit Card Type: MC / VISA / AMEX / DISCOVER (circle one)
MC / VISA / AMEX / DISCOVER (circle one)Number: __________________________Exp. Date: _______
Exp. Date: _______Name on CC:
Company Name on CC:oInvoice (statements sent on 10th of each month; payment due Thirty Days after Invoice Date)
Invoice (statements sent on 10th of each month; payment due Thirty Days after Invoice Date)MAILING ADDRESS: ________________________________________________________
CITY/STATE/ZIP:____________________________________________________________
Billing Address (if different from above)
___________________________
___________________________
PHONE #: ________________________
CONTACT PERSON:_______________________________________________
CONTACT E-MAIL:___________________________
__________________________________________________________
_____________________________PRINTED NAMEPRINTED NAME
PRINTED NAME___________________________________________________________
______________________________AUTHORIZED SIGNATUREAUTHORIZED SIGNATURE
AUTHORIZED SIGNATUREOnline SchoolRoom Customer Company Name ______________________
Customer Company Name ______________________5702B Taylor Draper Cove Address Line 1 ________________________________
Address Line 1 ________________________________Austin, TX 78759 Address Line 2 _______________________________
Address Line 2 _______________________________ City, State Zip Code _______________________________________________________ _______________________________
_______________________________DATE DATE
DATEEmail to: support@classroom-on-line.com or fax to: 888/742-6518
