5818 Rocky Point Dr.
San Antonio, Texas 78249
NEW CLIENT PROFILE
Company:___________________________________________________________________________
Bill to Address:_______________________________________________________________________
City, St., Zip:_________________________________________________________________________
Contact Name:_______________________________ Contact Email:____________________________
Phone:(________)___________________________ Fax:(________)____________________________
Ship to
(If Different)
Company:___________________________________________________________________________
Address:____________________________________________________________________________
(No P.O. Box)
City, St, Zip__________________________________________________________________________
TAXABLE RESALE TAX EXEMPT
(If Resale or Exempt Please Attach Copy of Certificate)
Principals Name & Title_________________________________________________________________
Federal Tax I.D. No._____________________________
Corporation Partnership Proprietorship
Years in Business____________________________ Duns Number______________________________
Fax (210) 734-0652 Phone (210) 734-5356 Toll Free (800) 842-0191
Credit Card Payment
M/C VISA DISCOVER AMEX
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expires __/__ /__
Last3digits on back of card above sig. line
__ __ __
Billing information on card
Name_____________________________________
Street Address______________________________
Zip Code__________________________________
Signature as it appears on Card
_________________________________________
Print Name
_________________________________________
Debit Payment out of your checking account:
Debit out of this account
Routing #__________________________
Account #_________________________
Signature for approval
____________________________________
Print Name
____________________________________
All orders are shipped UPS ground and charges are added at the time of shipping.
Sales tax applies to Texas customers only.
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