New Customer

Customer Name: *

Sale Tax ID: *

If non taxable please attach completed Certificate. Only PDF

Business Start Date:

Website:

Physical Address:

Accounts Payable Address:

Main Phone Number:

Main Contact Name:

Contact Email:

POs Required?:

Yes

No

Accounts Payable Phone Number:

Accounts Payable Contact Name:

Accounts Payable email for invoices:

Credit Requested:

Terms Requested:

Company Officers Name and email:

Bankruptcies, Lawsuits?:

Yes

No

BANK Reference INFO

Bank Name:

Bank Address:

Bank Officer:

Bank Phone:

Bank Email:

Company 1 Name:

Company 2 Name:

Phone Number:

Contact Name:

Contact Email:

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