New Customer

New Customer Form

This form is split into 2 sections. The top of the form contains contact information that we need from all new customers. The bottom section contains credit information if you wish to establish terms with us. Upon credit approval our terms are net 30 days. If you choose to only fill out the top, you will need to pay before we ship or deliver your product. If you do not wish to complete this form electronically you can download it by Clicking Here.
    *If exempt, please provide a copy of your tax exempt certificate. If you need to fill out a Tax Exempt form please find it here and download it and submit it by pressing the browse button and upload it.
  • Contacts

  • Company Officers

  • Buyer

  • Accounts Payable

  • *IF YOU WISH TO PAY C.O.D. PLEASE STOP HERE AND SIGN THE BOTTOM OF THIS FORM (a 3.5% processing fee will be added to invoices paid by credit card) IF YOU WISH TO ESTABLISH CREDIT TERMS PLEASE COMPLETE THE SECTION BELOW AND SIGN THE BOTTOM OF THIS FORM*
  • Credit References

  • Company Name
  • Company Name
  • Company Name
  • Bank Reference

  • Bank Name
  • I/We certify that all of the above information is correct. You may refer to any firm, individual or bank listed as references in considering this application. If credit terms are established I/we agree to pay for my/our purchases according to your terms of Net 30 Days payable from the invoice date. If the account becomes delinquent, I/we agree to pay the delinquent service charge of 1.5% per month (18% APY), and any collection, court expenses, and/or attorney fees deemed necessary by you to collect the debt.
  • Electronic Signature

  • This field is for validation purposes and should be left unchanged.