New Customer Information Form
Date:_____________________ Sales
Rep:________________________ Account # _______________
Company Name: ___________________________________ Type of
Business: ____________________
Street Address:________________________________________________________________________
City:___________________________________________________ State
_____ Zip _______________
Billing Address: (if
different)____________________________ Time in Business__________________
City: __________________________________________________ State _____
Zip ________________
Phone #______________________ Fax # _______________ Email
______________________________
A/P Contact:__________________________________________ Phone #
_________________________
E-mail:_______________________________________________
Any special billing instructions?
_______________________________________________________
Resale Tax # ________________ Purchase Orders? ________________ #
Invoice copies needed ________
Ship to:
______________________________________________________________
City: __________________________________________________ State _____
Zip ________________
Freight
terms____________________________________________________ R. Side _____
L. Side _____
A/P cut off _________________________________________ Other:
__________________________
Is your company a: [] Corporation? [] Partnership? [] Sole
Proprietorship?
(If Partnership or Sole Proprietorship, provide information on the
Principals below)
Name(s) of Principal(s):
1______________________________________
Title:_____________________________ SS#:________________
2______________________________________ Title:_____________________________ SS#:________________
3______________________________________ Title:_____________________________ SS#:________________
Who are you currently buying from on credit terms?
1______________________________________ Location ___________________
Phone _______________________
2______________________________________ Location ___________________ Phone _______________________
3______________________________________ Location ___________________ Phone _______________________
Your Bank
_________________________________________________________ Phone
_______________________
Location: _______________________________________ Contact
_________________________________________
Checking #______________________________________ Savings
#_________________________________________
On behalf of the above named company/business; I authorize
___________________________________ to run any
needed credit reports and or / contact my trade references for credit
ratings.
____________________________________________________
Authorized Signature
Anticipated Annual Volume?___________________
Percentage Margin? _____________________________
Date Approved: _________________ Approved By:
____________________________________________
Credit Line: (not limit) ___________ Terms and
Conditions of Sales ____________________________
Complete the Form & Fax immediately to:
________________________________ email: ______________________________
PROCESS AT ONCE – PENDING SALE !
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