New Application
Update Information
Business Name:
Mailing Address:
City/ST/Zip:
Vendor Representative Name:
Telephone Number:
FAX Number:
Toll Free Number:
E-Mail Address:
IMPORTANT: To submit this form electronically, you must enter an email address .
Identification

Federal ID #:
(If Individual, Social Security #)

Your Sales Tax Rate:

Arizona Sales Tax ID #:
Type of Organization
Individual Partnership Public Utility
Corporation Non-profit Government Agency
Type of Business
Consultant Broker Construction
Service Manufacturer Retailer
Factory Representative Wholesaler Surplus Dealer
Professional Service (specify)

Commodity/Service Offered:

Other Terms:
Invoice Terms:
Other Discounts:
Copy of PO Required?
FOB Point: