New Customer Setup Form

Today's Date - 9/7/2010
* Legal Name of Customer
*Email Address
*US Based? Yes    No
*PO Box / Street Address
*Country:
*State:
*City:
*In City Limits? Yes    No
County
*Zip Code
Ship to Address
*Shipping Address
*Country:
*State:
*City:
County
*Zip Code
*Type of Bussiness
*Vendor Location
*Bussiness Phone
*Bussiness Fax
*Is your Business Tax Exempt ? Yes No
Attach Certificate Here
Estimated Monthly Purchase
Number of Employees
Bussiness Start Date MM/DD/YY
A/P Contact
A/P Phone
A/P Fax
A/P Email
*Purchase Order Required Yes No
*Name of Bussiness Owner /Officer of Company
Guarantors 1
Guarantors Name
Guarantors Home Address
Guarantors Phone Number
Guarantors SSN 999-99-9999
More
Name of Bussiness Owner /Officer of Company
Guarantors 2
Guarantors Name
Guarantors Home Address
Guarantors Phone Number  
Guarantors SSN  999-99-9999
More Cancel
Name of Bussiness Owner /Officer of Company
Guarantors 3
Guarantors Name
Guarantors Home Address
Guarantors Phone Number  
Guarantors SSN  999-99-9999
Cancel
Bank References
Name
Address
Account Number
Phone
Contact
D&B (Dunn and Bradstreet Number)
Trade References
Name
Address
Account Number
Phone
Fax
Trade References
Name
Address
Account Number
Phone
Fax
Trade References
Name
Address
Account Numbers
Phone
Fax
Account Policy
Terms and Conditions: Accept    Decline
By pressing “Accept” you agree that all purchases from HD Supply, Inc. Industrial PVF will be governed by the terms and conditions located at http://www.sunbeltsupply.com/legalnotices/terms.html
In addition, you represent that all the information on the application is true and correct and that you have the authority to represent the applicant and to agree to such terms and conditions.
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