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Sales Rep Account Credit Form

Please enter the following information:
CUSTOMER INFORMATION

If the customer's "Ship To" address is different than their "Bill To", please enter it into the "Additional Comments" section below.
"Bill To"
Company Name:
Address 1:
Address 2:
Address 3:
City:
State:
Zip Code:
Phone:
Fax:

If you would like this customer to receive a copy of the JTF monthly newsletter, please fill in the following (if you need additional space, use the "Additional Comments" section below):
1.Contact Name:
E-mail:
2.Contact Name:
E-mail:
3.Contact Name:
E-mail:


Nature of Business:
SIC:


Submitted by:
Date:
E-mail:
Additional Comments:

 
   



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