| ${r}Contact name (last, first) | , | SS# | |||
|---|---|---|---|---|---|
| Company | |||||
| ${r}Address | |||||
| ${r}City | ${r}State/Country | ${r}Zip | |||
| Day Phone | |||||
| Night Phone | |||||
| Fax | |||||
| END print qq!Postal mail invoice | 
| Email invoice ', qq! | Billing type | 
| $paybychecked{$_}!; } else { print qq!> $payby{$_}!; } } print < | 
| Username | |
| Password | (blank to generate) | 
| POP | |