Intl
Customer Set-up Form
Please complete the entire form.
*
indicates field cannot be left blank. Use Tab to move from field to field
Date
*
Form Status: NEW
Form ID:
Your Contact Information
Salutation
Mr.
Mrs.
Ms.
First Name
*
Last Name
*
Your Department
*
Choose Closest
Accounting
Marketing
Owner/Manager
Sales/Purchasing
Service/Repair
Phone
*
Fax
Business Information
Company Name
*
Owner First Name
Last Name
Website
How did you hear about us?
*
Select Closest
GNE Catalog
GNE Staff
Magazine
Mailing
Manufacturer
Referral
Sales Rep
Tradeshow
Website
Other
Which one?
Intl Billing Address
Intl Shipping Address
Check here if Shipping Address same as Billing Address
(Do not use PO Address as ship to).
Address1
Address2
Address3
Address4
Address5
Address6
Address7
Country
Address1
Address2
Address3
Address4
Address5
Address6
Address7
Country
Dept
Contact
Email
Sales/Product Info
*
Check if Order Notification Contact/Email same as Sales/Product Info
Order Notifications
*
Check if Service Repair Contact/Email same as Sales/Product Info
Service/Repair
*
Check if Accounting Contact/Email same as Sales/Product Info
Accounting
*
Business Class
(you may select more than one)
Retail
Rental
Service
Distributer
End User
Comments:
CREDIT TERMS: ARE YOU REQUESTING CREDIT TERMS FOR YOUR ACCOUNT? Yes
GNE will complete a Dunn & Bradstreet report prior to establishing credit. If a report cannot be obtained, you will be asked to submit further trade and bank references before credit can be established. Should your company be granted credit, the following payment terms will apply: 1. Payment within 30 days, unless special terms have been set up. 2. All payments shall be made by cash, VISA, MasterCard, AMEX, Discover Card, money order, personal or company check. 3. All payments will be guaranteed by local bank, credit union, third party, etc. PLEASE READ THE FOLLOWING STATEMENT AFTER COMPLETING THIS FORM: I / we hereby certify that the information provided above is true and accurate. I / we have read the GNE Terms and Policies. I / we agree to the terms as written in the policies.
Agreed by
Company Title
Date
Click here to review Terms and Policies
Intl
Intl