REQUEST FOR NEW CUSTOMER ACCOUNT

DATE:

BUSINESS NAME:

ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

PHONE: FAX:

CONTACT:

RECEIVING HOURS:

SALES REP: SALES REP CODE:

PRIORITY: CREDIT APPLICATION: Y: N:

PRICE LIST: M: Q: S: A: PRICE CODE:

COMMENTS:

 

PLEASE NOTE: