New Account Form - Vinylmax

Sale Rep:*

Sales Rep Email*

Account Information

Account Name*

Is this account part of a corporate group?*

Yes
No

Region

District

Account Primary Contact*

First Last

Primary Contact Email Address*

Primary Address*

Address Line 1 Address Line 2 City State 9-Digit ZIP Code

Account Phone*

Account Fax

Billing

Please take the time to ask non-corporate accounts about where they'd like invoices to go so they are received and paid on time.

Billing Contact Name

First Last

Billing Email

Is the billing address the same as the primary address?*

Yes
No

Billing Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code

Billing Phone Number*

Billing Fax Number

This field is hidden when viewing the form

How does this account prefer to receive invoices?*

Is this account tax exempt?*

Yes
No

Tax ID form or certificate (this must be included or we will have to charge tax to this customer)

Max. file size: 128 MB.

Is a credit application needed for this account?*

Yes, sent already
Yes, going to send
No

Shipping

Is the shipping address the same as the primary address?*

Yes
No

Shipping Contact Name

First Last

Shipping Email (this recipients will receive truck content notifications)

Shipping Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code

Shipping Notes

Dock Location, Receiving Hours, Etc.

Is this a distributor or dealer account?*

Distributor
Dealer

(For National Branches) Which region and/or district is this location in?

Primary Product Family*

For ABC Supply Co. Please provide the names of the individuals at this branch who will need access to WEBcenter.

User #1

First Last

User #2

First Last

User #3

First Last

User #4

First Last

User #5

First Last

User #6

First Last

This field is hidden when viewing the form

For RICHARDS BUILDING SUPPLY: What is the email address they want their DMSI files sent to? (This is REQUIRED before the setup of the account)

Who are we taking business from?*

New Account Set Up Form

Step 1 of 4

Account Information

Billing

Shipping

Pricing

Marketing Contacts

Final Steps

Optional Questions