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New Customer Information

Please take a few moments and fill out this internet secure form in it's entirety. All field items are required to activate your account. An Advantage Supply account representative will contact you within 24 hours of submission with your assigned account number and password so that you will be able to access the special pricing available to your organization.

If you prefer you can click on this link to download a credit application to complete and fax to 1-866-280-1847.

Date

Company Name

Contact Name

Mail To Information:

Billing Address

Billing City

Billing State

Billing Zip Code

Phone Number

Fax Number

E-Mail Address

Shipping information: (If different from billing address)

Shipping Address

Shipping City

Shipping State

Shipping Zip Code

Credit Card Information:

Name on Credit Card

Credit Card Type

Credit Card Number

Expiration Date (00/00)

3 Number Security Code
(found on back of card)

Comments/Questions:

Credit Card purchases may be subject to a transaction fee (CCTF). The CCTF covers the cost to fulfill your order request when you purchase products online, by fax or by phone. This charge includes services like taking and maintaining your order on our point of sale systems, administration of credit card service fees, arranging for shipping, will call and/or coordinating with the distribution center. The CCTF is applied to an entire order.

*Note: This does not apply to state, federal, and non-profit institutions.