New Customer Form

Capital Data Sales Contact *

Legal Company Name *

DBA Name *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip

Billing Address (if different)

Address Line 1

Address Line 2

City

State

Zip

Purchasing Contact Name *

Purchasing Contact Phone *

Purchasing Contact Email *

Accounts Payable Contact Name *

Accounts Payable Contact Phone *

Accounts Payable Contact Email *

Payment Terms are Net 30 – Please Initial *

Sales Tax Exempt *

Sales Tax Exemption Certificate *

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Name