Business Pay Agreement

To obtain a hardcopy of the form contact INES at 410-742-5052 x118 to obtain the current rate agreement or email at INES@dila.org

Legal business or individual name:(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Email Address(Required)

Tax ID / EIN or personal ID (if applicable):

Billing contact name:(Required)

First Last

Billing Phone(Required)

Billing Email(Required)

Billing Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Accounts payable department details (if applicable):

Preferred communcation method for invoices:

The signature below indicates that the Rates Sheet has been reviewed, and invoices will be paid accordingly. Payment for services will be rendered within 15 days of invoice receipt

Printed Name and Title of Authorized Individual(Required)

Signature of Authorized Agent(Required)

Date(Required)