Shared Top Border
personnel services
2 OFFICES TO SERVE YOU BETTER!   University City   St. Louis  
 
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To expedite new customer requests, please submit the following form in its' entirety.  Thank you. 

 

   
  Firm Name:   Phone: 
       Address:        Fax: 
              City:   State:      Zip:  
 Billing Address:  
             City:   State:   Zip:  
 
Name of Owners, Partners or Officers
 
Federal I.D. number:      D/B number:    
Type of Business:     Years in Business:    
 Accts. Payable Contact:               Phone Number:
 
TERMS OF PAYMENT DISCUSSED WITH PATRIOT PERSONNEL SERVICES:
Net 10 Days 
 Net 15 Days  Net 30 Days 
 
REFERENCES
        Firms Name:   Fax Number:  
        Firms Name:   Fax Number:  
        Firms Name:   Fax Number:  
Banking Facility:   Fax Number:  
Account Number:           Contact:  
 
 
I agree that the information furnished on this page is for the purpose of obtaining credit from your firm and that I am authorized in my capacity to bind my firm accordingly. I further understand and agree that all accounts or monies due you shall be due and payable to: PROGRESS SERVICE GROUP, C/O PATRIOT PERSONNEL SERVICES, P.O. BOX 775167, ST. LOUIS, MISSOURI 63177.
 
Authorized Name and Title:  
                                        Date:  
 

 


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