Customer Account Setup Form

Customer Account Setup Form

This information will help DuraPlaq meet your needs and get you setup with a prospective customer account. We look forward to having the opportunity to earn your business!
Name*

First NameLast Name
*CALC NAME
Email*
example@example.com
Online Form Submission Date

MonthDayYear
Date
Type of Business*

Professional Artist / PhotographerAmateur Artist / PhotographerRetailer (Print / Frame Shop)Corporation / FranchiseInterior DesignerArt ConsultantContractorGalleryPersonal UseOther
Company Name
Company Website
Billing Address
Street Address
City
State
Postal / Zip Code
Primary Phone Number*

Area CodePhone Number
Mobile Number

Area CodePhone Number
Is Your Shipping Address The Same As Your Billing Address

YesNo
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are You A Tax Exempt Entity or Have a Sales Tax License For Resale Purposes

YesNo
Resale License Number
State of Sales Tax Registration
Please Upload a Copy of Your Sales Tax License or Exemption Letter Below If Available

Browse Files

Cancelof
Sales Tax Exempt Form
Please Upload a Copy of Above Sales Tax Exempt Certificate To Complete Tax Exempt Status (Can Be Submitted at a Later Date)

Browse Files

Cancelof
Sales Tax Type

TAX EXEMPTOut of StateTax Mead ColoradoTax Denver ColoradoTN State Sales Tax (7%)Out of State - STL ON FILEColorado State Sales Tax
Do You Have a Dedicated Accounts Payable Contact?

YesNo
Accounts Payable Contact
Accounts Payable Email
example@example.com
Accounts Payable Phone Number

Area CodePhone Number
Accounts Payable Email
example@example.com
Do you require a copy of the invoice be sent to any other Contacts?

YesNo
Does the Accounts Payable Dept Have the Same Address as the Primary Company Address?*

YesNo
Accounts Payable Address
Street Address
City
State
Postal / Zip Code
Preferred Payment Method

Credit CardCash Upon PickupCredit Terms* (Pending Credit Approval)CheckI Will Establish Payment Preference Later
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