New Customer/Ship To Form

NEW CUSTOMER / SHIP TO FORM

dd-mm-yyyy

New Customer New Ship To

CUST#

Change Of Bill To Change Of Ship To

SALES#

BILL TO COMPANY NAME

BILL TO CONTACT NAME

BILL TO ADDRESS

BILL TO CITY

STATE

ZIP

BILL TO PHONE

FAX

E-Mail

PREFERRED INVOICE / STATEMENT RECEIPT METHOD

Mail Fax Email

TAX STATUS

Exempt Resale Exempt Container

PLEASE ATTACH TAX CERTIFICATE

WILL CUSTOMER EVER RECEIVE DELIVERIES TO BILL TO ADDRESS

Yes No

IF CUSTOMER HAS A DIFFERENT SHIP TO ADDRESS, PLEASE FILL IN BELOW

SHIP TO COMPANY NAME

SHIP TO #

SHIP TO ADDRESS

SHIP TO CITY

STATE

ZIP

SHIP TO CONTACT

SHIP TO PHONE

PLEASE ENTER CUSTOMER BUSINESS HOURS

BUSINESS OPEN TIME

CLOSE TIME

PREFERRED DELIVERY TIMES

PREFERRED DELIVERY TIMES ( MINIMUM 4 HOURS)

CUSTOMER TAKES DELIVERY DURING LUNCH

Yes No

DAYS CUSTOMER IS CLOSED

DAYS CUSTOMER DOES NOT WANT DELIVERY:

SPECIAL INSTRUCTIONS

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