Account Setup

Account Setup & Credit Application

Please complete the information below to setup an account and credit terms for your company.
Call 866-649-8665 x 706 if you have any questions.

Company Name (requ'd):

DUNS Number:

Federal Tax ID:

State Tax Exempt #:

Ship-To Street (requ'd):

Ship-To Suite/Bldg:

Ship-To City (requ'd):

Ship-To State (requ'd):

Ship-To ZIP Code (requ'd):

Receiving Contact (requ'd):

Receiving Phone # (requ'd):

Billing same as ship-to?

yes

Bill-To Street:

Bill-To Suite/Bldg:

Bill-To City:

Bill-To State:

Bill-To ZIP Code:

Billing Contact:

Billing Phone #:

Method of Payment:

wire transfer

credit card

check

Special Instructions:

2900 Westinghouse Blvd. - 118 | Charlotte, NC 28273 | 1-866-649-8665 toll free

1-866-649-8665 fax