New Customer Form
Billing address:
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What is your companys Name?
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First Name
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Last Name
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Street Address
Address Line 2
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City
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State/Province/Region
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Zip/Postal Code
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Phone Number
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Fax number
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Country
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Email Address
Who is your branch manager?
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First Name
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Last Name
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Phone Number
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Fax Number
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Email Address
Who is your purchasing agent?
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First Name
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Last Name
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Phone Number
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Fax Number
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Email Address
Who will our contact be in your accounts payable department?
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First Name
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Last Name
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Phone Number
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Fax Number
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Email Address
Bank Information:
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Please provide the institute name, address, account number, telephone number, and a contact name
Shipping Information
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What is your Federal Tax ID unber:
(only for US customers)
please put N/A if you are a non US customer.
*
Ship to address one
Ship to address two
Ship to address three
Ship to address four
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When ordering small parts under 150 LBS
What courier would you like to use?
If you wish for us to pre pay and charge
your freight charges on the invoice please
select UPS as we receive excellent rates.
UPS
Fed EX
DHL
Other
If you selected "Other" please provide here
Do you wish to provide an account number for the courier
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When shipping over 150 LBS do you have a
preferred carrier?
No, you pick best way
Yellow
TST
Go-Jit
UPS supply chain
Roadway
ABF
Cabano
Midland
Other
If you selected "Other" please provide carrier
Do you wish to provide an account number for your carrier?
For Ontario customers only:
Are you PST exempt?
If yes please fill out our PST exemption certificate
Yes
No
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