Customer Setup Form

Brabazon Contact

CORPORATE INFORMATION

Legal Business Name

TIN

dba

DUNS

Corporate Street Address

City

State

Zip

Phone

PO Required

Yes

No

Email for Invoices

Email for AP Inquiry

CONTACT INFORMATION

Buyer

First

Last

Buyer Phone

Buyer Email

Accounts Payable

First Name

Last Name

Accounts Payable Phone

Accounts Payable Email

CFO / Accounting Manager

First Name

Last Name

CFO / Accounting Manager Phone

CFO / Accounting Manager Email

LOCATIONS / SHIP TO ADDRESSES

Ship To Street Address

Ship To City

Ship To State

County

Zip Code

Street Address

City

State

County

Zip Code

TAX EXEMPT STATUS

Tax Exempt

Yes - attach tax exemption certificate(s) below

No

Please attach required documentation here.

Maximum file size: 67.11MB

Completed Request By:

First

Last

Email

Phone

Website/URL

Terms

- Payment Terms are Net 30.
- Acceptable payment methods include ACH, Check, Bill.com or Brabazon's Accounts Receivable Portal by ACH or credit card.
- Credit card payments will incur up to a 3% processing fee.

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