Wufoo

New Customer Application

ABCO Wholesale Distributors, LLC.

Note: You must be a business to apply for a commercial account.

Name * First Last
Business Name *
Business Phone Number * ### - ### - ####
Business Fax Number ### - ### - ####
Email *
Account Type -How would you like your account to be set up? *
C.O.D. Purchase Card ( card #'s can be obtained via phone for security reasons) Net 30 (Credit)
For Net 30 Credit Customers Only

Customers who choose to have credit are required to fill out this part of the form. This is the same as our business credit application form only in an online version.
Type of Business
In Business Since:
Business Type
Corporation Partnership Proprietorship
Name of Principal Owner
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number ### - ### - ####
Accounts Payable Contact First Last
Accounts Payable Phone Number ### - ### - ####
Accounts Payable Fax Number ### - ### - ####
Bank References: Name / Acc# / Address / Phone #
Credit References: Co. Name / Contact / Phone # / Fax # (minimum of 3 references)
Non-Taxable Companies
Resale Farmer Used in Mfg Charities/ Religous Fed Government / Municipal Non-Profit Other
Tax Exempt Number (A copy of your tax exempt certificate must be faxed to us at 860-826-1568)
Shipping Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Enter Multiple ship to's here:
Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Additional Comments:
Do Not Fill This Out