New Customer Application

If you would like to become an Wearcode Trends customer, please complete the following form.

"*" indicates required fields

Date

Business Name:

First

Owner / Buyer:*

First Last

Billing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Resale Certificate:

Max. file size: 500 MB.

Please attach a copy of your resale / tax ID license to this application. Except for states that are exempt, this form is required - incomplete applications will not be processed. The following states are exempt: AK, DE, MT, NH, OR, PA, RI, NJ, MN, non-usa.

Ship To Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone:*

Mobile:

Business Fax:*

Email Contact:*

Accounting Email:*

Required for Paperless Invoicing

Similar Lines Carried?:*

Years in Business?:*

Annual Sales Volume:*

How did you hear about us?

Were you contacted by a Sales Rep and if so, who?