DEPOT CUSTOMER SETUP FORM

Facility Name:

Shipping Address:

City:

State:

Zip:

Contact Person:

Phone:

E-mail address:

Title:

Billing Address:

City:

State:

Zip:

E-mail address for Invoice:

Billing Contact Person:

Phone:

E-mail address:

Title:

Preferred Carrier:

Account #

Insure Value: Yes / No

Directions for return (if any):