Customer Intake Form

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Legal business name ^*

DBA

Website

Year established

Industry

Type

If Other, specify

Street address ^*

City ^*

State ^*

ZIP ^*

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Federal EIN ^*

State tax ID

DUNS (optional)

If your organization is tax exempt, attach applicable exemption certificates (PDF, JPG, or PNG).

Tax exempt certificate file 1 (max 2 MB)

Browse

Tax exempt certificate file 2 (max 2 MB)

Browse

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Billing address same as primary? ^*

YesNo

Billing street

Billing city

Billing state

Billing ZIP

Primary A/P contact

Full name^*

Title

Email ^*

Phone

Industry

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Preferred invoicing method EmailPortalEDIMail

Invoice email

Invoice portal URL

Preferred payment method

If Other, specify

Payment terms are Net 30 days upon approval.

Bank name

Branch city

Branch state

Branch ZIP

Contact name

Phone

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Primary shipping address (if different from billing)

Street

City

State

ZIP

Shipping address 2

Street

City

State

ZIP

Shipping address 3

Street

City

State

ZIP

1.Company
Information
2.Tax
Registration
3.Primary A/P
Contact
4.Invoicing &
Payment
5.References &
Contacts
6.Shipping
7.Authorize &
Submit

Authorization

I certify that the information provided is true and correct. If credit is requested, I authorize verification of banking and trade references.

I have read and agree to the certification above.

Name ^*

Title ^*

Email ^*

Phone ^*

Electronic signature (type full name) ^*

Date ^*

Have you completed all sections? If you have a separate document with this information you may email it to credit@setco.com.

Completed application form
Tax exemption certificate(s), if applicable
Trade references
Bank references

Customer Intake Form

Setco HQ Contact Information

Products

Services