New DSD Customer Setup

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

Yes No
If YES, what is the store number?
Store Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Store Phone Number

Area Code Phone 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?: *

Yes No
Bills Sent To?: *
Sales Division? (Kroger Columbus Div., etc):
Special Pricing (vending, etc.):
Was Free Fill Given?: *

Yes No
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