New Customer Information Form

Company Information
Company Name*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Invoice Preference*
- Mail
- Email
- Both
A/P Contact
A/P Contact Name*
First Last
A/P Contact Phone*
A/P Contact Email*
Purchasing Contact
Purchasing Contact Name*
First Last
Purchasing Contact Phone*
Purchasing Contact Email*
Service Location
Service Location Name*
Address*
Street Address City State ZIP Code
Other Notes or Special Instructions
Terms
- Payment terms are Net 30 unless otherwise stated.
- If tax exempt, we must have a copy of a completed ST3 form, which can be downloaded here. Please mail these to 14430 21st Avenue North Plymouth, MN 55447 or fax to (763) 235-2410
- Service location name will appear on the invoice

Company Information