New Customer Information Form

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NEW CUSTOMER INFORMATION FORM
Please complete the following information in order to set up an account. Once this form is received and you are set up
in our system we will fax your account number to you.
Fax: Attention Account Setup Dept.
Fax#: 800-370-8706
Company Name: __________________________________ Contact Name: _______________________________
Street Address: ______________________________________________________________________________ _
City: _____________________________________State: _____________Zip Code: ________________________
This Address is:
Residential
Commercial
Phone #: (______) ________-________________
Fax #: (______) _______-_______________
Federal Tax ID Number: ____________________________ Resale Number: ______________________________
REQUIRED
REQUIRED
Type of Business
Business Area
Sole Proprietor
ASI Member, ASI #: ________________
Partnership
Screen printer/Transfers
Corporation
Embroider
Screen printers only
Do you have any automatic printing equipment?
YES
NO
If YES how many machines: ________________ and how many stations? __________________
Embroiders only
How many embroidery heads do you have? ___________
Would you like to receive:
Faxblasts
NO
YES
Eblast
NO
YES
EMAIL ADDRESS TO BE ADDED
Current Wearable Wholesaler Supplier: 1)______________________ 2)______________________
Annual Wearable Purchases:
00000-9,999
100,000- 249,999
10,000- 24,999
250,000- 499,999
25,000- 49,999
5000,000- 749,999
50,000- 99,999
750,000- 999,999
Number of outside Sales Representatives: _________________________________________________________
Number of Years in Business: ___________________________________________________________________
How did you hear about us? ____________________________________________________________________
What two brands do you sell most of? 1)______________________________2)___________________________
All new accounts are set up COD Certified (cash, certified check, or money order). If it is preferred to write a company
check, apply for terms, or use a credit card; a confidential credit application and/or authorization needs to be filled out.
Please contact our Sales Department for an application. We look forward to doing business with you!
***River’s End Use Only***
Account #:__________________ Date: ___________________ CSR: ____________________________
Order Placed: Y or N
Catalog Sent: Y or N
Follow-up Call: Y or N
Comments:

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