New Customer Form - FXR Glass

New Customer Form

Company name

Physical Address

CITY

STATE

ZIP

Mailing Address (if different)

Phone

Cell

Fax

ap email address

AP Contact Person

Legal Entity

TAX ID#

Resale Certificate State

Resale Certificate #

Website URL

Description of operations

Business References:

Reference Name #1

Phone #1

Address

City/State

Account #

Reference #2

Reference Name #2

Phone #2

Address

City/State

Account #

Reference #3

Reference Name #3

Phone #3

Address

City/State

Account #