Home / Residential / Commercial / Supplies / Naugahyde / Outdoor Fabrics / About Us / Our Location / How to Order Order Form / Request Samples / Open an Account
47 Mall Drive • Commack, NY 11725516-932-3838 • 800-645-7560 • Fax: 631-410-0213
YOU MAY PRINT OUT THIS FORM FOR FAX OR MAIL
NAME____________________________________
COMPANY________________________________
ADDRESS 1_______________________________
ADDRESS 2_______________________________
CITY_____________________________________
STATE/ZIP________________________________
PHONE__________________EMAIL____________
TYPE OF BUSINESS (check one):
Single Proprietorship________
Partnership_______
Corporation_______
Taxable? Yes _____ No _____
Please choose the payment method that best suits your business:
Open Account____
Credit Card - Complete this section
COD/Check_____
Visa _______Master Card _______Discover ______Amex______
Credit Card Number
Expiration Date
Card Holder's Name
Signature
TRADE REFERENCE 1
Company Name:
Contact Person:
Address:
City/State/Zip
Phone:
Fax:
E-Mail:
Remarks:
TRADE REFERENCE 2