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New Customer Information Sheet

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Account Information
Account # (if known)
Tax Exempt Yes      No
Billing Information
Customer Name
Billing Address
City
State
Zip
Phone # ( ) -
Fax # ( ) -
Email (for shipping notification)
Accounts payable contact
Purchasing contact
Payment Options
Sales Permit #
(if tax exempt we must have a copy of the sales tax permit)
DUNS #
Payment options NET30      Credit Card      COD
Requested credit $
(if requesting credit please supply either your DUNS # or trade references)
First order date ,
First order amount $
Shipping information
Customer Name
Shipping Address
City
State
Zip
County
Inside city limits YES      NO
Phone # ( ) -
Fax # ( ) -
Mercer webmail