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* Name
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* Company Name
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* Email
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Phone
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Fax
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* Billing Address
Please include Department, Street or PO,
City, State, and Zip.
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* Shipping Address
If different than billing, please include
Department, Street, City, State, and Zip.
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* Special Shipping Requirements
(Time, location or other.)
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* Billing Contact
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Does your company require a Purchase Order?
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Accounting Phone Number
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Accounting E-mail Address
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* Accounting Fax
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* Would you like to order online?
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* Name of person Authorized to set up this account.
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Buyer Information:
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Buyer 1
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Email Address
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* Approved to purchase online?
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Buyer 2
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Email Address
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Approved to purchase online?
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Buyer 3
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Email Address:
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Approved to purchase online?
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Additional Information:
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*Current Supplier
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*Number of employees in your office
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*An automatic temporary limit will be set on your account.
Please indicate below the average amount you spend per month on your
office products. Our accounting department will contact your payables contact for any further information needed.
Average Monthly Purchases.
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* Please Specify Preferred Payment Type:
Invoices will be emailed the following day unless specified to mail.
If you choose to pay by credit card, we will contact you directly for your credit card information.
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Email Invoices To:
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Do not email invoices. Use regular mail.
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Preferred ID
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Preferred Password
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* Tax Exempt?
In order to process orders without charging tax, please fax your tax exempt certificate prior to placing your first order.
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* How did you hear of us?
If you've been in contact with a sales rep,
please indicate his/her name.
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Special Instructions or Needs:
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