New Customer Form - The Brown Company, Inc

Business Name

Tax ID

Shipping Address

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred method of payment

Code Certificate Are

Resale/Sales Tax Exempt?

Yes
No

Please Upload Your Resale Certificate

Click or drag a file to this area to upload.

Contacts

Please provide us with 2+ of your business’ contacts that we can reach out to for questions.

Owner Name

Title

Phone

Email

Invoicing/AP Contact Name

Title

Phone

Email

Other Contact Name

Title

Phone

Email

Invoice Instructions

Click or drag a file to this area to upload.

If you have any special invoice/billing instructions or portal access documentation, please upload it here.

Are you applying for credit?

Trade References

Please provide us with three references – businesses you are working with or who you have recently worked with who can attest to your creditworthiness.

The Brown Company, or its designee, has my authorization to obtain credit information from my vendors.

Clear Signature

By execution of this application, I agree to pay within the payment terms and to pay interest at the rate of 1.5% per month on unpaid balances or as allowed by law, whichever is lower. If my account is placed for collections, I also agree to be responsible for all reasonable counsel fees and court costs incurred.