New Customer Form

BUSINESS CONTACT INFORMATION

Company Name

DBA / Established Year

Phone / Fax

Main AP Contact Name/Title

Phone / Fax / Email

BUSINESS CONTACT INFORMATION

Tax Identification / Number DUNS

Primary Business Address

City / State / Zip Code

Phone / Fax / Email

Bank Name /Bank Address

Phone / Fax / Email

Total amount of sales orders ?

More than 50,000 USD

Less than 50,000 USD

BUSINESS/TRADE REFERENCES

Check if COD Customer

Company/ Type of Account

Address

City / State / Zip Code

Phone / Fax / Email

Company/ Type of Account

Address

City / State / Zip Code

Phone / Fax / Email

Company/ Type of Account

Address

City / State / Zip Code

Phone / Fax / Email

Requested Amount of Credit

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