Intrac Form C - Reseller Surcharge Remittance Form

ADVERTISEMENT

InTRAC FORM C
RESELLER SURCHARGE REMITTANCE FORM
Name of Company _______________________________________________________
Year
Month Surcharge
#Lines Portion Prorated
Amount Tendered
____ _____ $0.03___
______ ____________
______________
I affirm that the information contained herein is true and accurate to the best of my
knowledge, information and belief.
______________________________
Authorized Signature
______________________________
Printed Name
_____________________________
Telephone Number
Make checks payable to: InTRAC
Mailing Address:
InTRAC
7702 Woodland Drive, Suite 250
Indianapolis, IN 46278
317-334-1413
877-446-8722 toll free
effective 4/1/05

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Intrac Form B - Cellular Surcharge Remittance Intrac Form B - Cellular Surcharge Remittance Business
Form 751 - Surcharge Remittance Form Form 751 - Surcharge Remittance Form Legal
Form 751 - Surcharge Remittance December 2009 Form 751 - Surcharge Remittance December 2009 Financial
Surcharge Remittance Form - Oregon Public Utility Commission Residential Services Protection Fund Surcharge Remittance Form - Oregon Public Utility Commission Residential Services Protection Fund Legal
Iowa Wireless Enhanced 911 Surcharge Remittance Iowa Wireless Enhanced 911 Surcharge Remittance Legal
Wireless E-911 Services Board Wireless E-911 Surcharge Remittance Form - Commonwealth Of Virginia Wireless E-911 Services Board Wireless E-911 Surcharge Remittance Form - Commonwealth Of Virginia Legal
Utah Universal Service Fund Surcharge Remittal Statement Form Utah Universal Service Fund Surcharge Remittal Statement Form Legal
Wireline And Wireless Telephone Monthly E9-1-1 Surcharge Remittance Form Wireline And Wireless Telephone Monthly E9-1-1 Surcharge Remittance Form Financial
Wireless Enhanced 911 Surcharge Remittance Form Wireless Enhanced 911 Surcharge Remittance Form Legal
Telephone And Wireless Monthly E9-1-1 Surcharge Remittance Form Telephone And Wireless Monthly E9-1-1 Surcharge Remittance Form Financial

Related Categories

Parent category: Business
Download
Go