General Information

Customer, Vendor, or Both? Customer, Vendor, or Both? *CustomerVendorBoth

Tax Exempt? Tax Exempt? *YesNo

Company Name

Company Mailing Address

Company City location

Company State location

Company Zip Code

Company Phone Number

Company Website

EIN Number (Vendor)

Tax Resale Number (Customer)

Company Email Address

Main Contact Name

Main Contact Title

Main Contact Phone Number (If different than Above)

Main Contact Email (If different than Above)

Main Contact Address (Include City, State, & Zip)

Billing Contact Email (If different than Above)

Optional Information Optional Information Add Shipping Information? (Customer) Add accounting contact for all POs and Invoices?

Street Address

City

State

Zip Code

Shipping Contact Name

Shipping to Residential? Shipping to Residential? *YesNo

Dock Available? Dock Available? *YesNo

Forklift Available? Forklift Available? *YesNo

Shipping contact Number

Shipping contact Email

Shipping/Receiving Hours

Account Number

Re-enter Account Number

Routing Number

Bank Name

SWIFT Code (International Banks Only)

Bank Address

Billing Contact Name

Accounting Contact Name

Accounting Contact Title

Accounting Contact Phone Number

Accounting Contact Email

Accounting Contact Address (Include City, State & Zip)

Addition Information

Attach Certificate of Insurance File InputChoose FilesNo Files ChosenAccepted file types: png, csv, pdf, doc. Max. file size: 1 MB

Attach W9 File InputChoose FilesNo Files ChosenAccepted file types: png, csv, pdf, doc. Max. file size: 1 MB

Attach Tax Exemption Form File InputChoose FilesNo Files ChosenAccepted file types: png, csv, pdf, doc. Max. file size: 1 MB