NEW CUSTOMER REQUEST FORM

New Customer Registration - Bandanna Warehouse

Company Name*
Trade Name/DBA (if different than above)
Website
Corporate Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Address (If different than above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Telephone Number*
Tax ID/DUN's Number*
Sales Tax Exempt Number*
Is Company Publicly or Privately Held?*
Company Website
President/CEO*
Name
Accounts Payable Name*
Name
Accounts Payable Phone*
Accounts Payable Email*
Accounts Payable Fax #
Accounts Receivable Name*
Name
Accounts Receivable Number*
Accounts Receivable Email*
Accounts Receivable Fax #
Controller Receivable Name
Name
Controller Number
Controller Email
Controller Fax #
Buyer 1 Name*
Name
Buyer 1 Number*
Buyer 1 Email*
Buyer 1 Fax #
Buyer 2 Name*
Name
Buyer 2 Number*
Buyer 2 Email*
Buyer 2 Fax #
Prepaid Account Only*
- Credit Card
- Certified Check
- Wire Transfer
Please check your method of payment
Resale Tax Cert./Tax Exemption*
Drop files here or

Accepted file types: jpg, pdf, Max. file size: 64 MB, Max. files: 3.
Please upload a copy of you Resale Certificate or Tax Exempt Certificate. *Note* You will not be able to send this form without uploading your document(s)
Return Policy*
I agree to the return policy.
Claims should be made within 60 days from receipt of goods and before goods are used. Goods should not be returned without prior written conset.