New Customer Form

New Customer Application:
Company Information:
Bill To Company Name*
Parent Company (if applicable)
NAICS Code
EIN / FED TAX ID
Bill to Address*

Bill to Street Address

Bill to Street Address Line 2 (if line 3 needed, add after comma)

Bill to CityBill to State / Province

Bill to Zip CodeBill to Country
Bill to Phone Number*
Bill to Fax Number
Web Address
Do you have a different 'Ship to' Address?

YesNo
Ship to Company Name*
Ship To Street Address*

Ship to Street Address

Ship to Street Address Line 2 (if line 3 needed, add after comma)

Ship to CityShip to State / Province

Ship to Postal / Zip CodeShip to Country
Ship to Phone Number
Additional Ship To Street Address

Ship to Street Address

Ship to Street Address Line 2 (if line 3 needed, add after comma)

Ship to CityShip to State / Province

Ship to Postal / Zip CodeShip to Country
Ship to Phone Number
Receiving Hours
Preferred Freight Method
Packaging Requirements
Preferred Freight Method
Purchasing Manager / Buyer*
Accounts Payable Contact*
Additional Contact
Primary Industry*
Are the sales to your company taxable?*

NoYes
If sales to your company are not taxable, please provide tax exempt form here*

PDF files are preferred
Cancelof
State*
Full state name or abbreviation (Ex: VA or Virginia)
In what county are sales to your company taxable?*
How did you hear about UPM?
Additional Comments
Please select the UPM Account Specialist You're Working With *
UPM Account Specialist Email
Do you need open payment terms and a credit limit?*

YesNo
If you are requesting Open payment terms and a credit limit, you will need to also fill out a credit application. A link to the credit application will be provied on the 'thank you' screen once you have submitted the new customer form.

Submission
Please sign and submit to complete this application
Date*
Please Enter Full Name*

First NameLast Name
Title*
E-mail*

Confirmation Emailexample@example.com
The undersigned hereby certifies, on behalf of their company, that the information being provided is true and accurate.

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New Customer Application:

Company Information:

Please sign and submit to complete this application