New DSD Customer Setup

New Customer Setup
Sales Rep Name:*
Route #:*
Email Address:*
Store Name*
Is this a chain store?:*

YesNo
If YES, what is the store number?
Store Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Store Phone Number

Area CodePhone Number
Contact Name
Handheld Delivery Day
HANDHELD Serviced Before or After which customer #?
BEFORE:
AFTER
Type of Store (grocery, golf, gas, etc.):
Charge OR Cash?*
Has a credit application been submitted if charge?:*

YesNo
Bills Sent To?:*
Sales Division? (Kroger Columbus Div., etc):
Special Pricing (vending, etc.):
Was Free Fill Given?:*

YesNo
If YES, what was wholesale value? (enter 0 if not applicable - $0.00):*
Don't forget to complete a Sale Request form for "HOT" deals!
Comments:
ATTENTION: PRINT a copy for your records before sending. Form will NOT email you a copy. Please dismiss if form tells you it was received as spam. * Items are required to submit the form.
Should be Empty:

New Customer Setup