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Please fill out the new client information below to set up a new account.

Today’s Date:

Company Name:

Address:

Contact name:

Phone:

Ext:

How many deliveries per week do you have? (estimate)

Do you have any special request?

Is there a parent company who will be responsible for the bill? Y N

We do billing every 30 days and expect payment within 30 days. If this is a problem please let us know.

Some clients have the need for PO #’s to be listed on the bill. Any things such as this can be accommodated.