KGM New Account Signup

New Account Setup
New Account Setup/Information Form
Company E-Mail: *
MainLine:

Area Code Phone Number
Back Line:

Area Code Phone Number
Fax:

Area Code Fax Number
Legal Company Name *
Physical Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Billing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Accounts Payable Mgr:

First Name Last Name
Direct Line/Ext

Area Code Phone Number
Purchase Order Required? *

Yes No
Special billing instructions:
Co. Contacts:
Invoicing:

Invoice Only Invoice & Delivery Ticket Invoice, Delivery Ticket & Bill of Lading
Account Rep: *

First Name Last Name
Cell Number

Area Code Phone Number
Should be Empty:

New Account Setup/Information Form