Company Name:*
 
 
Website:
 
 
 
Customer Service Contact Information
 
 
 
 
First Name:*
 
 
Last Name:*
 
 
 
Phone Number:*
 
 
Email Address:*
 
 
 
Do you have a web-based vendor portal?
 
 
If yes, portal address:
 
 
 
Buyer Purchase Contact Information
 
 
 
 
First Name:*
 
 
Last Name:*
 
 
 
Email Address:*
 
 
Phone:*
 
 
 
Preferred method to place order:
 
 
 
 
Email Order Confirmation To:
 
 
Email Return Authorization To:
 
 
Email Shipping Confirmation To:
 
 
Marketing Contact Information:
 
 
 
 
First Name:*
 
 
Last Name:*
 
 
 
Phone:*
 
 
Email:*
 
 
 
Logistics Contact Information:
 
 
 
 
First Name:*
 
 
Last Name:*
 
 
 
Receiving Hours:*
 
 
 
 
Shipping Address:*
 
 
 
 
City:*
 
 
State / Province:*
 
 
Zip / Postal code:*
 
 
Phone Number*
 
 
Email:*
 
 
 
Is Delivery Appt Required:
 
 
If So, Contact Name:
 
 
Tailgate Required:
 
 
A/P Contact Information
 
 
 
 
First Name:*
 
 
Last Name:*
 
 
 
Billing Address
 
 
 
 
Email:*
 
 
Phone:*
 
 
 
City:*
 
 
State / Province:*
 
 
Zip / Postal Code:*
 
 
Preferred Method Of Invoicing:
 
 
Email Invoice To:
 
 
 
US Customers: Please Email Tax Exemption/Resale Certificate To: ar.vancouver@glendimplexamericas.com