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Portals New Account Set-Up Please complete the below form legibly and completely. Business Name__________________________________________________________________ Billing Address:__________________________________________________ City___________________________State____________Zip_________________ Shipping Address:__________________________________________________ City___________________________State____________Zip_________________ Phone:_________________________________ Fax:_____________________________________ Email:___________________________________________________________________________ Website: N Y _______________________________ Hours of Operation: _________________ Contact Person First :____________________________Last:_______________________________ Owner First:________________________________ Last:__________________________________ Accounts Payable First:_______________________________ Last:__________________________ Would you prefer to receive your statements via: email fax both (please circle) How did you hear about us?_______________________________________________________ Do you have a showroom? YES NO (please circle) *Please return with business card / business letterhead* Notes:________________________________________________________________________________ _____________________________________________________________________________________ Please visit our website portalshardware.com to register, view your pricing, order online and view product templates. Please allow 1 business day maximum for new account set up.

PH: 816.942.7413

FX: 816.942.7414

email@portalshardware.com

Portals Account Set-Up  

New account set-up form

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