customer-setup-form-editable

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Customer Setup/Maintenance (THIS IS NOT A CREDIT APPLICATION)

iDate iSales Person iBusiness Name (Input name as it appears on checks)

iDba iBilling Address iCity

iState

iZip

iShipping Address (If different from billing address)

iCity

iState

iZip

iPrimary Contact

Secondary Contact

iPhone No.

Phone No.

Cell No.

Cell No.

Fax No.

Fax No.

Email

Email

iTaxable: YES NO Tax Exempt No. Tax Jurisdiction iIf you are Tax Exempt, you must provide a copy of your Tax Exempt Certificate. iPurchase order required: YES

NO

iCustomer type (mark the category that best suits your business)

RESTAURANT HOTEL GROCERY

BAR SCHOOL CASINO

HOSPITAL CHURCH CONTRACTOR

BAKERY STATE/GOVERNMENT OTHER

iSTARRED ITEMS ARE REQUIRED INFORMATION – failure to provide this information could result in order processing delays. FOR INTERNAL USE ONLY

Account # Entered by:

Warehouse # Date: 2136 Reading Road y Cincinnati, OH 45202 Phone: (513) 421-4700 y Fax: (513) 639-4090


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