Please fill in the fields below:
Click here to print this form for your records and fax to (951) 848-9241 for processing.
Agent Name:
Company Name:
Billing Address:
City:
State:
Zip:
Cell Phone:
Office Phone:
Fax Number:
SERVICE AREA
Delivery Address
Map Page Code
Cross Streets
Sign Post Information
Color:
Flyer Box:
Solar Light:
Use Credit Card On File
Credit Card Number if Different than Card on File
Authorized Users of this account other than Above
Credit Card Information
Name on Card:
Visa
Mastercard
American Express
Discover
Number on Card:
Expiration:
Security Code:
Initials
By placing your initals in the box, this gives Sign Post Express the authority to charge your credit card for the sign post to be placed at the above address on the contract.
Please initial the following:
Initials All orders are based on the individual address for the installation. No post should be removed or moved. Should a post be moved to another address, you will be charged a fee for service for that area in which the post has been moved to.
Initials Post are rented from Sign Post Express and it's your responsibility to ensure that the post will return to our inventory at the termination of the contract for each post. Should a post become missing, removed or damaged by a non-employee of Sign Post Express, you will charged an additional $60.00 for the missing post.
Initials Flyer boxes are rented from Sign Post Express and it's your responsibility to ensure that the flyer box will return to our inventory at the termination of the contract for each post. Should a flyer box become missing, removed or damaged by a non-employee of Sign Post Express, you will be charged an additional $15.00 for the missing flyer box.
Initials Sign Post Express offers free sign storage. Should you have no activity for a year on your account, we will attempt to contact you with the information you have provided. If no contact is made within a 30 day period, your account will be closed and the signs will be disposed of.
Initials All riders and personal property will be removed from the post at the termination of the contract prior ro the post removal.
Initials Buyer agrees to pay a reasonable sum for an attorney fees incurred by the seller in the event a suite is required to collect for any goods or services sold.
Initials It is your responsibility to update changes in address or changes in authorized users of this account.
The undersigned certifies that the above information on the application is correct and terms of payment are understood.
