NEW CUSTOMER REQUEST FORM

New Customer Bandanna Warehouse

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 (3% surcharge will apply)
- Certified Check
- Wire Transfer (2$25 fee)
- ACH (May take up to 2 days)
Please check your method of payment
Resale Tax Cert./Tax Exemption*
Drop files here or

Accepted file types: jpg, pdf, Max. file size: 256 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.
Phone
This field is for validation purposes and should be left unchanged.