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Customer Setup Form
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Company Name
*
Company Legal Name
Company Physical Address
*
Company Mailing Address
*
Your Name
*
First
Last
Your Phone Number
*
Your Email Address
*
Accounting Contact
*
First
Last
Accounting Contact Email Address
*
Tax Information
*
Employer Identification Number
Dun & Bradstreet Number
Requested Billing Terms
*
Average Days to Pay
Billing Requirements
*
Does your company have any special requirements for billing purposes ? (Ex. Purchase Order Number, Rate Document, Sales Order # Etc ...)
Submit