Account Set-Up Form

Company/Customer Name *

Primary Account Contact *

First Name Last Name

Title / Position *

Primary Contact Phone Number *

Area Code Phone Number

Primary Email Address *

example@example.com

When order is complete, how would you like to be notified? *

Phone Email

Is Official Company Name the same as shown above? *

Yes No

Official Company Name *

Billing Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Shipping Address same as Billing? *

Yes No

Shipping Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Shipping Site Name/Description *

Site Phone Number *

Area Code Phone Number

On-Site Contact *

First Name Last Name

Shipping Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Do you have another Shipping Address to add?

Yes No

Shipping Address #2 *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Shipping Site Name/Description *

Site Phone Number *

Area Code Phone Number

On-Site Contact *

First Name Last Name

Do you have another Shipping Address to add?

Yes No

Shipping Address #3 *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Shipping Site Name/Description *

Site Phone Number *

Area Code Phone Number

On-Site Contact *

First Name Last Name

Accounting Contact Information

Where shall we send billing/invoices? *

Primary Account Contact Accounting Contact Both

Accounting/AP Contact Name *

First Name Last Name

Title / Position *

Accounting/AP Number *

Area Code Phone Number

Accounting/AP Email Address *

How do you prefer to receive Invoices/Statements? *

USPS Mail Email

Account Tax Status

Do you have Resale ID/Tax Exempt Status? *

Yes, I will provide my Transaction Privilege Tax Exemption Certificate No, I prefer my Account to be taxable

Please Upload Current AZFORM 5000/5000A (Links to each form are provided below.) *

Browse Files

Arizona TPT Exemption Certificate - General

Arizona Resale Certificate - Form 5000A

Requested Terms

All new accounts are COD. Based on consideration of volume and frequency of order(s), we are able to offer terms after initial orders. In many instances, even with terms, volume projects are still subject to Deposit Requirements.

Are you interested in applying for Credit Terms with USA Hall of Frames *

Yes No

Name of Principal Business Owner *

First Name Last Name

Year Founded *

Type of Business *

Bank Information

Bank Name *

Routing # *

Account # *

City, State *

References

Trade Reference #1 *

Contact Name *

Phone Number *

Area Code Phone Number

Email *

example@example.com

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Trade Reference #2 *

Contact Name *

Phone Number *

Area Code Phone Number

Email *

example@example.com

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

All information is correct.

Yes