New Customer Setup


This completed form is required from the sales rep to set up a new account.

17%

General Information

*
*
*

Address

*
*
*
*
*
*
*
*
*

Contact Information

Account Information

*

Authorized Contact for Pricing/Product Updates

*
*

Principal Contact Information

*
*

Purchasing Contact Information

*
*

Payables Contact Information

*
*

Purchasing Information

*
*
*
*

Required Labeling Information

*
*

Payment Information

*

For security purposes, Americo does not accept credit card information online.

Please provide the name and phone number of a contact who will be responsible for payment and an Americo Customer Service Representative will be in contact.

*
*

Credit Reference 1

*
*
*

Credit Reference 2

*
*
*

Credit Reference 3

*
*
*

Credit Reference 4

*
*
*