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Please List the Saleman's name that has been in contact with you:
Company Name:
Billing Address:
Street Address
City
State
Zip Code
Shipping Address:
Street Address
City
State
Zip Code
Telephone Number:
Area Code
-
Phone Number
Fax Number:
Area Code
-
Phone Number
Type of Business:
Date Established:
/
/
day
month
year
Type of Ownership:
Proprietorship
Partnership
Corporation
A Sales & Use Tax Certificate Form is required for any
Tax Exempt Customers
Please provide one Bank and three Trade Credit References Below
Bank:
Bank Address:
Street Address
City
State
Zip Code
Bank Phone Number:
Area Code
-
Phone Number
Bank Fax Number:
*
Area Code
-
Phone Number
Bank Account #:
1) Trade:
1) Trade Address:
Street Address
City
State
Zip Code
1) Trade Phone Number:
Area Code
-
Phone Number
1) Trade Fax Number:
*
Area Code
-
Phone Number
1) Trade Account #:
2) Trade:
2) Trade Address:
Street Address
City
State
Zip Code
2) Trade Phone Number:
Area Code
-
Phone Number
2) Trade Fax Number:
*
Area Code
-
Phone Number
2) Trade Account #:
3) Trade:
3) Trade Address:
Street Address
City
State
Zip Code
3) Trade Phone Number:
Area Code
-
Phone Number
3) Trade Fax Number:
*
Area Code
-
Phone Number
3) Trade Account #:
List Owners or Corporate Members Below
1. Name
1. Title
1. Phone
Area Code
-
Phone Number
1. Address
Street Address
City
State
Zip
2. Name
2. Title
2. Phone
Area Code
-
Phone Number
2. Address
Street Address
City
State
Zip
3. Name
3. Title
3. Phone:
Area Code
-
Phone Number
3. Address:
Street Address
City
State
Zip
Please check the boxes below if you require any of the following:
Monthly Statement
Invoice
Delivery Ticket
Fax #:
Area Code
-
Phone Number
E-mail Address:
SDS Sheets
Please note that our system will send a SDS the first time a product is bought that requires an SDS.
If your company uses products requiring SDS Sheets, would you like it:
Faxed
Emailed
Sent with Invoice
Person to receive SDS Sheet:
Recipient Fax Number:
Area Code
-
Phone Number
Recpienent E-mail:
If applicable, please list any delivery instructions (i.e. business hours, closed for lunch, drop-off site/dept, etc.)
Other Necessary Contacts (i.e. Accounts Payable, Purchasing, etc.)
1) Name
2) Name
3) Name
1) Title
2) Title
3) Title
1) Phone
-
2) Phone
-
3) Phone
-
I certify that the above information is true. This information is to be used only for opening a line of credit with Diamond Paper Company
Signature:
Date:
Title:
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