Corporate Information
Corp. Name
Office Address
City	St  AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KY LA KS MA MD ME MI MN MO MS MT NB NC ND NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY      Zip
Phone Number	Fax Number
Website URL	E-mail
Billing Information (if different)
Address
City	State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KY LA KS MA MD ME MI MN MO MS MT NB NC ND NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip
A/P Contact	E-Mail
A/P Phone #	A/P Fax #
	Bank Information
Name	Phone
Address
City	ST AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KY LA KS MA MD ME MI MN MO MS MT NB NC ND NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY   ZIP
	Business Reference 1
Name
Relationship
Contact	Phone Fax
	Business Reference 2
Name
Relationship
Contact	Phone   Fax
	Business Reference 3
Name
Relationship
Contact	Phone   Fax

General Information

Regular Contact Person?
Contact Phone #
Fax #
E-Mail Address?
Emergency / After Hour Contact?
Emergency  / After Hour Phone
Beeper/Cell #

HELP US FOLLOW  YOUR COMPANY POLICIES    

Do you use Purchase Orders or Work Order numbers?	NO YES
Are only certain people allowed to order / receive work & merchandise?	Yes, I will supply list of names NO, Anyone from our company
Do you have multiple locations?	Yes, I will supply a list NO
Do all locations get billed to above billing address?	YES NO
Do you have a tax exemption or  trade resale number?	YES NO           ID Number
Do you require evening (after 5pm) or 24 hr service?	YES NO
Other special requirements