Please Fill out the Form / 38.107.191.105 / 38.107.191.105
Section 1 - Customer Billing Information
Company
Address
City
State
Zipcode
Country
Jurisdiction Code
Phone
Fax
Email

Section 2 - Customer Shipping Information
  Same as billing?
Company Name
Address
City
State
Zipcode
Country
Jurisdiction Code
Phone
Fax
Email

Section 3 - Sales Area Information
Type Of Industry Distributor
Type Of Business Wholesale Tiles
Customer Group
Sales Group

Section 4 - Payment & Price List Information
Payment Terms COD Net 30
Price List Distributor Florida
Tax Exempt? All accounts are opened Taxable unless a tax exempt form is provided.

Section 5 - Customer Accounting Contact
Customer Accounting Name
  Address same as shipping info? Address same as billing?
Address
City
State
Zipcode
Country
Phone
Email

Complete?
To be entered by
Notes: