New Customer Form

New Customer Form

Thank you for your business! Please fill out this form to ensure the smoothest onboarding process.
Business Information
Business Name
DBA Name
Business Category
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Delivery Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years in This Business
Facility Status
If Lease, How Long
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
At This Location?
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Type of Business
If Incorporated, In What State
Owner Information
Owner Name

First NameLast Name
Owner Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous Address (if at current address less than 6 months)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Desired Payment Terms
Select your preferred payment terms.
Billing and Credit Contact
Billing Contact Name

First NameLast Name
Billing Contact Email
example@example.com
Billing Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Billing Instructions
Credit and Banking Information

Dear Customer: We would appreciate basic financial information so that we may document our records and as a basis for credit extension to you. This information will be held in strict confidence. A credit report will be pulled, and the application must be signed.
Approximate Credit Requested
Name of Bank or Financial Institution
Bank Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Office Manager or Account Representative

First NameLast Name
Account Type
Account Number
Trade References
Trade Reference 1 Name

First NameLast Name
Trade Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Trade Reference 1 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Trade Reference 2 Name

First NameLast Name
Trade Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Trade Reference 2 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Trade Reference 3 Name

First NameLast Name
Trade Reference 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Trade Reference 3 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Signature and Agreement
PLEASE SIGN HERE AFTER READING ENTIRE APPLICATION. SIGNATURE MUST BE BY OWNER OR CORPORATE OFFICER.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name

First NameMiddle NameLast Name
Title
Signature
*A CREDIT REPORT WILL BE PULLED BASED ON THE ABOVE INFORMATION.

*Payment Terms: NET30: you will have 30 days from the date of the invoice to pay your invoice. The undersigned does request that credit be extended by Gem State Paper & Supply as set forth above, and in consideration thereof, guarantees payment of the foregoing as and when due.
Payment Terms: Net-Due after invoiced delivery. No later than the 10th of the following month. Past due thereafter.
POLICY ON RETURNED ITEMS & TERMS OF SALE:
- No returns after 14 days
- Minimum 15% Restocking Charge on all returned items
- Proof of Purchase required for returned Items
- No Returns on: Sale items; close outs; special orders; opened food/food service items; soiled, stained, or non-sellable items; items not in original container; open liquids; or factory seal broken items.
Terms: Net due after invoiced delivery. No later than the 10th of the following month. Accounts past due are subject to a "HOLD" of merchandise or COD on order only.

Finance Charge: A finance charge of 18% will be charged on any accounts past due, which is a monthly finance charge of 1 1/2% per month.

Returned Checks: There is a $20 charge on all returned checks.

SHORTAGES AND DAMAGES

Must be called to our attention within 48 hours of deliver or receipt of merchandise.

SPECIAL ORDERS MAY REQUIRE DEPOSIT OR TO BE PREPAID

Prepaid Delivery on Our Trucks: Delivery on our regular scheduled trucks is PREPAID. Delivery made to business accounts only and will not be left without authorized signature.

SALES TAX

Shipments: All orders F.O.B. our warehouse, shipping and handling fee is $4.95.

Tax certificate must be on file or sales tax will be charged.
Should be Empty:

New Customer Form

Business Information

Owner Information

Desired Payment Terms

Billing and Credit Contact

Credit and Banking Information

Trade References

Signature and Agreement