Become a Dealer for NDY Manufacturing

New Wholesale Customer Information Form
Customer Information
Company Name:*
Company Name:*
Email: **
Phone*
Customer Billing Information AP
Company Name:*
Phone*
AP Email: **
Address*
Address Line 2 City State / Province / Region ZIP / Postal Code
Customer Shipping Information
Untitled*
Address*
Address Line 2 City State / Province / Region ZIP / Postal Code
Consent
By signing below, I certify all information is true and correct to the best of my knowledge and I accept the credit terms listed above. TERMS: 30 DAYS - A 1.5% Service Charge per month (18% ANNUAL RATE) on account balances 30 days past statement date
Signature*
Date:*
MM slash DD slash YYYY

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