Sign up to Pay Online

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Retailer Name *

Address *

I would like to pay my bills online through the Retailer Portal or TermSync? *

Business License Name *

Doing Business As (DBA) *

Try-It Distributing Account Number *

Bank Name *

Bank Routing Number *

Checking Account Number

I would like to reduce clutter and do my part to help the environment. Please sign me up for Paperless Billing.

Name *

First

Last

Email *

Primary Number *

Type of Phone – Primary *

Secondary Number *

of License Name

Type of Phone – Secondary *

Your Try-It Distributing Sales Rep Name *