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Please List the Saleman's name that has been in contact with you:
Company Name:
Billing Address:
Shipping Address:
Telephone Number:
-
Fax Number:
-
Type of Business:
Date Established:
 / 
 / 
Type of Ownership:

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:
Bank Phone Number:
-
Bank Fax Number:*
-
Bank Account #:

1) Trade:
1) Trade Address:
1) Trade Phone Number:
-
1) Trade Fax Number:*
-
1) Trade Account #:

2) Trade:
2) Trade Address:
2) Trade Phone Number:
-
2) Trade Fax Number:*
-
2) Trade Account #:

3) Trade:
3) Trade Address:
3) Trade Phone Number:
-
3) Trade Fax Number:*
-
3) Trade Account #:

List Owners or Corporate Members Below

1. Name
1. Title
1. Phone
-
1. Address

2. Name
2. Title
2. Phone
-
2. Address

3. Name
3. Title
3. Phone:
-
3. Address:
Please check the boxes below if you require any of the following:
Fax #:
-
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:
Person to receive SDS Sheet:
Recipient Fax 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: