New Customer Application

Business Name *

Business Email

CIP Sales Rep

Contact Name

Contact Phone

Contact Email

Are you applying for terms?YesNo

Contact Name

Contact Phone

Contact Email

Terms

Stocking Agreement?YesNo

Accounting Contact Name

Contact Phone

Contact Email

Payment Remittance Address

Year Established

Tax Resale ID

Type of BusinessIncorporatedSole ProprietorLLC

Tax File

Delivery Contact Name

Contact Phone

Contact Email

Delivery Days, Hours

Loading dock available for delivery?YesNo

Dock Appointment Required for Delivery?YesNo

Preferred Method of DeliveryCustomer PickupDelivery