Home Page

Please be sure to fill in the application completely to ensure the fastest responce.

- Account Application Form - * These are required fields
Part I: Business Information
Business Name: *
ASI # *
Date:
Physical Address: (Street) (City) (State) (Zip)
Type of Business: Corporation LLC Partnership Proprietorship
Bank of Record: (Name) (Contact) (Account #)
Part II: Contact & Mailing Information
(1) Main Contact(2) Accounts Payable Contact
Name
Position
Name
Position
Mailing Address Mailing Address
City
State Zip
City
State Zip
Phone * Fax Phone Fax
E-mail * E-mail
Part III: Trade References (5 required)
1.Company Account # Fax
2.Company Account # Fax
3.Company Account # Fax
4.Company Account # Fax
5.Company Account # Fax
Part IV: Acknowledgement
The undersigned certifies that all information in this registration form is complete, factual, and correct. Glass Graphics will rely on the accuracy of this information for the purpose of establishing your account and determining any credit terms that may be extended. In signing this registration form the signatory hereby authorizes Glass Graphics to contact any parties listed herein to verify the information contained in this form.
Authorized Signature: *
Title of Signatory:
Date:
 
       Print this page.
Glass Graphics
Specializing in Crystal, Wood, Marble & Nickel Plated Products.

Email: Customer Service
Call Customer Service: 877-730-0818 or 603.447.1900
Glass Graphics 56 Pleasant St. Conway, NH 03818
2004, 2005 Copyright, all rights reserved.

BR> 2004, 2005 Copyright, all rights reserved.