Government & Agency Sales

Government & Agency Sales
Agency Name *
Department Name (if applicable)
Complete Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Purchasing Contact Information *

First Name Last Name
Purchasing Contact Phone Number *

Area Code Phone Number
Purchasing Contact Email *
example@example.com
Accounts Payable Contact Information *

First Name Last Name
Accounts PayablePhone Number *

Area Code Phone Number
Accounts Payable Email *
example@example.com
Please select the options below if they apply to your agency:

A formal purchase order is required to charge to our account Our employees are required to be given a copy of the invoice when they come in-store to pick up Take a deposit for all back orders Email all invoices to the accounts payable contact
Terms & Condition

- Purchasies being charged to your account can not be submitted by phone. Orders are required to be sumitted by email or fax. A hard copy may be given in person as well.

- Invoices must be paid within 30 days. All delinquent accounts will be placed on a credit hold.

- Report any discrepancies withing 15 days of receipt of product.

- Account statments will be sent to the accounts payable email.
Request Type *
Items / Quantities
Comments / Messages
Should be Empty: