New Customer Information Form

Welcome!

Thank you for choosing Cimino’s Cabinet Doors for your fine quality Cabinet Doors.We are looking forward to our new business relationship, and will be here to assist you at any time. For our records, we will need for you to complete this form in order to set up your account and to ship your order on the date you are given. Once we have received this, a member of our Sales Team will contact you to process your order. If you prefer, you may fax this form by downloading the PDF version of this form and faxing it to us at 866-636-8105

* = required information

*Company Name:
*Billing Address:
*City:
*State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    *Zip:
*Ship-to Address:
*City:
*State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    *Zip:
*Nearest Cross Street:
*Email Address:
*Contact Name(s):
*Phone Number:
Fax Number:
Cell and/or Pager Number:
Owner Name:
Owner Home Phone Number:
Driver's License Number:
*Do we charge you sales tax?	Yes    No If not, you must fax or mail a copy of your resale card.
In which county will we be delivering your order?
*Authorized By:
*Title: