Please complete and fax to (503)282-1416
MercuryPDX Account Information
Date         Account Number(office use only)  
Business Information
Business Name              
Street Address              
City     State Zip        
Telephone #   Fax #     E-Mail Address  
Billing Information (if different)
Attention to   Telephone #   Fax #    
Business Name              
Street Address              
City   State Zip   E-Mail Address  
Name of Authorized Payment Person   Specific Instructions    
Terms                
All established businesses will receive immediate credit terms by faxing this form to (503)282-1416. All accounts are billed bi-monthly, and terms are net 10 days. Past due amounts over 30 days will be charged 1.8% monthly interest on any unpaid balance. Please call our office at (503)247-8484 if you need more information.
                 
Signature           Date    
Print Name         Title    
Mercury Messenger
P.O. Box 2274 Portland OR 97208-2274