Customer Setup/Maintenance (THIS IS NOT A CREDIT APPLICATION)
Date Location Alack SRE, Sarasota SRE, Ft. Myers Lotz
Sales Person Business Name
(Input name as it appears on checks)
Dba Billing Address City
State
Zip
Shipping Address (If different from billing address)
City
State
Zip
Primary Contact
Secondary Contact
Phone No.
Phone No.
Cell No.
Cell No.
Fax No.
Fax No.
Taxable: YES NO Tax Exempt No. Tax Jurisdiction If you are Tax Exempt, you must provide a copy of your Tax Exempt Certificate. Purchase order required: YES
NO
Customer type (mark the category that best suits your business)
RESTAURANT HOTEL GROCERY
BAR SCHOOL CASINO
HOSPITAL CHURCH CONTRACTOR
BAKERY STATE/GOVERNMENT OTHER
STARRED ITEMS ARE REQUIRED INFORMATION – failure to provide this information could result in order processing delays. FOR INTERNAL USE ONLY
Account # Entered by: ALACK – North Shore 17420 Highway 190 Hammond, LA 70401 (985) 345-9476
Warehouse # Date:
SRE – Sarasota 5330 Pinkney Ave. Bldg. C Sarasota, FL 34233 (941) 924-1410
SRE – Fort Myers 1962 Honda Dr. Fort Myers, FL 33907 (239) 226-4555
LOTZ – New Orleans 5133 River Rd. Harahan, LA 70123 (504) 733-3790