New Customer Profile Form

First Name*
Last Name*
Email*
Phone*
ADDRESS
CITY
State*
Customer Name*
Please Ship Samples To:
LAST NAME
Phone
State*
Zip*
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)
Explanation*
EDI CAPABLE
- NO
- YES (Give Contact Name)
Contact Name
SHIPPING
- Direct Shipping
- Customer Pick-up
PICK-UP ALLOWANCE*
BROKER
- NO
- YES
NAME OF BROKER*
LABEL HOUSE
- NO
- YES
Name of Label House*
- Marketing Program
Notes*
- Shows
Notes*
- Growth Program
Notes
- Allowances
Notes
- Accurals
Notes
- Kettle Program
Notes
Sales Representative*
- Dee Felici
- Lewis Marshall
- Dennis Smith
CAPTCHA
File
Max. file size: 300 MB.

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