New Customer Info Page

New Customer Application Form

Fill out the form below and one of our team members will contact you soon.

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Company Name *

Billing Address *

City *

State *

Zip Code *

Office Phone *

hold Company Zip

Contact Name *

Email *

Shipping Information *

Does the company hold a tax exemption certificate? (a copy will be required on file) *

• Yes
• No

Submit

Please email your Federal Tax ID & a copy of your Tax Exempt Certificate to: bjohnson@countryspringswholesale.com

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