New Account Application

Customer Name*

Customer Type
Retail National AccountEcommerceDistributorGovernmentIndependent Retailer

Business Contact Information

Company Name*

Billing Address*

Company Tax ID (EIN)*

Company D&B*

Company Phone Number*

Buyer Contact Information

Buyer Name*

Buyer Email*

Buyer Phone Number*

Distributor - Do you currently have a purchasing relationship with a distributor

Distributor Name

Distributor Contact Name

Distributor Email

Credit Information

Net Terms
Due upon receipt (customers must apply for credit terms after the 1st order)Net30

Credit -If you select yes, please see the credit application form here.

YesNo

Class of Customer
Health and BeautySight LossArts and GraphicsIndustry & InspectionEcommerceSewing & Crafts

Freight Charges
Charge to customer's freight accountDelivered (freight included in customer pricing)Bill freight to customer on invoice

Freight Terms*

Accounting

Accounting Contact Name*

Accounting Email Address*

Accounting Phone Number*

Invoice Email Address*

Shipping

Shipping Address*

Shipping Contact Name

Shipping Phone Number

Shipping Email Address*

Freight Carrier

Carrier*

Freight Number*

Hours of Operation*

Is Lift Gate Necessary at your Delivery Point*

Logistics

Logistics Contact*

Logistics Contact Email*

Logistics Contact Phone*

PO Issues/Concerns

Backorder/Short Ship Contact*

Backorder/Short Ship Email*

Backorder/Short Ship Phone*

Marketing

Marketing Contact*

Marketing Email*

Marketing Phone*

Contract

Contract Contact*

Contract Email*

Contract Phone*

Images/Copy

Contact*

Email*

Phone*

Business Notes

Slotting Fees?

Other?

Damages %

Advertising Coop %

Company Information

Who do you sell to?

What platforms do you sell on?

What other names do you sell product under?