Property/Location Add on
Property Location/Ship to Address
Management Company
*
Name
*
First Name
Last Name
Email
*
example@example.com
Property Phone Number
*
Please enter a valid phone number.
Address
*
Property Name
Street Address
City
State / Province
Postal / Zip Code
Purchasing Contact
*
First Name
Last Name
Bill To Address
Bill To Address
*
Bill To Name
Street Address
City
State / Province
Postal / Zip Code
Bill To Phone Number
*
Please enter a valid phone number.
Bill To Email
*
example@example.com
Do you except backorders?
*
Yes
No
PO Number Required?
*
Yes
No
Number of Units at Property
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
*
“By providing a telephone number and submitting the form, you are consenting to be contacted by SMS text message and agreeing to our Privacy Policy. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out of further messaging. Reply HELP for more information."
Terms of Payment
Invoices are due 30 days from the invoice date. A minimum charge of $2.00 or 1.5% per 28-day cycle, 18% per year, may be charged on the past due invoices. I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, the undersigned also authorizes all creditors/banks to accept a photocopy of the signature and release credit information to Direct Supplies Warehouse, Inc.
Privacy Policy
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