New Customer Profile Form **** State*AlaskaAlabamaArkansas*Please Ship Samples To:LAST NAMEPhoneState*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EASTARMED FORCES AMERICA (EXCEPT CANADA)ARMED FORCES PACIFICDelawareFloridaGeorgia* PRICING: *Select LIST if we are billing at List Price and Customer is deducting off invoice.* Contract Pricing (see attached) List Pricing ** TERMS* Net 15 Other (Give Explanation) * EDI CAPABLE NO YES (Give Contact Name) SHIPPING Direct Shipping Customer Pick-up * BROKER NO YES * LABEL HOUSE NO YES * Marketing Program * Shows * Growth Program Allowances Accurals Kettle Program Sales Representative* Dee Felici Lewis Marshall Dennis Smith CAPTCHAFile
