Company InformationCompany*Address* Street Address City State / Province / Region ZIP / Postal Code Phone*FaxService ContactPhoneEmail Billing ContactPhoneEmail Account PreferencesInvoice FrequencyWeeklyMonthlySemi-MonthlyJob Reference Required?YesNoWhat do you call your reference? (Job #, PO #, etc.)Invoice DeliveryE-mailU.S. MailFREE WEB ACCESS - Place orders, track, view invoices, run reportsUsernamePasswordPayment InformationName of Card HolderType of CardNote: For security purposes someone from our business office will contact you shortly for your credit card account informationShipping Declaration of Value (At least 5 characters, case-sensitive)In consideration of the rate charged, it is agreed that the declared value of any single shipment, whether consisting of one or more items, is not more than $100, and that the liability of NY Minute for loss or damage, irrespective of the cause of such loss or damage is limited to $100. If you would like to declare a greater value of a shipment, the value must be declared and insurance must be purchased in advance. Claims not made within 5 days shall be deemed waived by the shipper/customer. Should any claim be asserted by any third party, the shipper agrees to hold NY Minute harmless against any claims, including attorney fees, irrespective of the cause of the loss or damage.SignaturesI understand the terms stated and above authorize NY Minute to charge the credit card provided above.SignaturePrint NameDate Date Format: MM slash DD slash YYYY How did you hear about NY Minute?PhoneThis field is for validation purposes and should be left unchanged.