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Corporate Account Application

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* indicates required fields

Bill To:		Ship To: (If different than Bill To)
* Firm Name:		Firm Name:
Street Address:		Street Address:
City:		City:
State:		shipState:
Zip:		Zip:
* Individual:		Individual:
Phone:		Phone:
Fax:		Fax:
* Email:		Email:

Credit Information (must be filled out for all new accounts):
A.	Customer Tax Exempt No Yes
B.	Customer is a Corporation Partnership Individual
C.	Business location is Owned Rented
	No. of employees
D.	How long has customer been in business
	How long at present address?
E.	If this is a branch office or subsidairy, give location of headquarters or indicate name of parent organization.
	#branch#
F.	Customer's Bank
G.	Customer buys from the following concerns on an open account basis: (please provide phone and fax numbers)
	1.
	2.
	3.
	4.

Verify image:

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#cfcatch.message#

Enter text as shown above *

Dear #firm_name#: Thank you for contacting Adirondack Ad Specialties. Your application for a corporate account has been received. Adirondack Ad Specialties Neil, You have received a new message from your website's Corporate Account Application form. * --------------------------------------------------------* Bill To Info: * Firm Name: #firm_name# * Email: #email# * Individual: #individual# * Street Address: #address# * City: #city# * State: #state# * Zip: #zip# * Phone: #phone# * Fax: #fax# Ship To Info: * Ship Firm Name: #ship_firm_name# * Ship Address: #shipAddress# * Ship City: #shipCity# * Ship State: #shipState# * Ship Zip: #shipZip# * Ship Individual: #shipIndividual# * Ship Phone: #shipPhone# * Ship Fax: #shipFax# * Ship Email: #shipEmail# Business Information: * Tax Exempt: #taxExempt# * Type Business: #typeBusiness# * Business Location: #businessLocation# * Number Employees: #numberEmployees# * Business Years: #businessYears# * Year(s) At Address: #yearAtAddress# * Branch: #branch# * Bank: #bank# * Concern 1: #concern1# * Concern 2: #concern2# * Concern 3: #concern3# * Concern 4: #concern4# Dear #firm_name#: Thank you for contacting Adirondack Ad Specialties. Your application for a corporate account has been received. Adirondack Ad Specialties Neil, You have received a new message from your website's Corporate Account Application form. * --------------------------------------------------------* Bill To Info: * Firm Name: #firm_name# * Email: #email# * Individual: #individual# * Street Address: #address# * City: #city# * State: #state# * Zip: #zip# * Phone: #phone# * Fax: #fax# Ship To Info: * Ship Firm Name: #ship_firm_name# * Ship Address: #shipAddress# * Ship City: #shipCity# * Ship State: #shipState# * Ship Zip: #shipZip# * Ship Individual: #shipIndividual# * Ship Phone: #shipPhone# * Ship Fax: #shipFax# * Ship Email: #shipEmail# Business Information: * Tax Exempt: #taxExempt# * Type Business: #typeBusiness# * Business Location: #businessLocation# * Number Employees: #numberEmployees# * Business Years: #businessYears# * Year(s) At Address: #yearAtAddress# * Branch: #branch# * Bank: #bank# * Concern 1: #concern1# * Concern 2: #concern2# * Concern 3: #concern3# * Concern 4: #concern4#

Adirondack Ad Specialties :: Imprinted Business & Advertising Gifts :: ADK Promos

Corporate Account Application

Bill To:

Ship To: (If different than Bill To)

Credit Information (must be filled out for all new accounts):