CUSTOMER SETUP FORM

Customer Orders Contact

First Name

Last Name

E-mail

Phone

SHIPPING INFORMATION

Customer Facility Name

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Receiving Contact

First Name

Last Name

SHIPPING CHARGES

* Customer FedEx Account †

ACCOUNTS PAYABLE

Accounts Payable Contact

First Name

Last Name

A/P E-Mail

A/P Phone

BILLING ADDRESS (if different than above)

Company Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

CTM SALES REPRESENTATIVE

Distributor Name

Sales Representative

First Name

Last Name

† If no FedEx account number provided, the following shipping charges will apply: $50 Standard / $75 Priority / $125 First AM