Born/BOC New Account Form

Bor n / BOC Ne w Accoun t For m
□ New Acco u n t
□ New Sh ip To
□ New Ow n er
124 West Pu t n am Aven u e
Gr een w ich , CT 06830
1-888-444-2769 - Ph o n e
1-203-661-1818 - Fax
w w w .b o r n sh o es.co m
ADDRESS INFORMATION
Billing Addr ess
Co r p o r at io n Nam e
St o r e Nam e
St r eet Ad d r ess
Cit y, St at e, Zip
Co n t act Nam e
Ph o n e Num b er
Fax Num b er
Ship To
St o r e Nam e
St o r e Num b er
St r eet Ad d r ess
Cit y, St at e, Zip
Co n t act Nam e
Ph o n e Num b er
Fax Num b er
ESERVICE INFORMATION
Nam e
Lo gin
Passw o r d
Em ail Ad d r ess
SHIPPING INFORMATION
Please ch eck b o xes w h ich ap p ly (if o t h er p lease sp ecif y in b lan k sect io n s)
SHIPPING METHOD:
UPS
RPS
OTHER
PREPAID
COLLECT
OTHER
PAYMENT METHOD:
Ar e t r uck sh ip m en t s allo w ed ?
Tr uckin g Co m p an y?
Weigh t Req uir ed f o r t r uck sh ip m en t s?
ORDER INFORMATION
Please Cir cle On e:
Okay t o p r esh ip ?
YES
NO
Backo r d er ?
YES
NO
PO n um b er r eq uir ed o n o r d er s?
YES
NO
Dep ar t m en t n um b er r eq uir ed ?
YES
NO
If yes, w h at d ep ar t m en t n um b er ?
Ar e yo u cur r en t ly d o in g b usin ess w it h an o t h er HHBr o w n d ivisio n ?
YES
NO
If yes, w h ich d iviso n ?
SIGNATURES
Cust om e r :
Dat e
Sale sp e r son :
Dat e
Sale s Man ag e r Ap p r ov al:
Dat e
Ne w Accoun t n um b e r :
Dat e
* All Te r m s ar e n e t 3 0
Heritage Group / div of HH Brown New Account Form
□ New Account
□ New Ship To
□ New Owner
124 West Putnam Avenue
Greenwich, CT 06830
1-203-302-6403 - Phone
1-603-250-2899 - Fax
ADDRESS INFORMATION
Billing Address
Corporation Name
Store Name
Street Address
City, State, Zip
Contact Name
Phone Number
Fax Number
Ship To
Store Name
Store Number
Street Address
City, State, Zip
Contact Name
Phone Number
Fax Number
ESERVICE INFORMATION
Name
Login
Password
Email Address
SHIPPING INFORMATION
Please check boxes which apply (if other please specify in blank sections)
SHIPPING METHOD:
UPS
RPS
OTHER
PREPAID
COLLECT
OTHER
PAYMENT METHOD:
Are truck shipments allowed?
Trucking Company?
Weight Required for truck shipments?
ORDER INFORMATION
Please Circle One:
Okay to preship?
YES
NO
Backorder?
YES
NO
PO number required on orders?
YES
NO
Department number required?
YES
NO
If yes, what department number?
YES
NO
If yes, which divison?
Are you currently doing business with another HHBrown division?
SIGNATURES
Customer:
Date
Salesperson:
Date
Sales Manager Approval:
Date
New Account number:
Date
* All Terms are net 30
□ Ne w Ow n e r
□ Ne w Accoun t
□ Ne w Sh ip To
H.H. Br ow n Wor k & Out d oor Gr oup
Ne w Accoun t For m
Ph on e : 8 0 0 -4 4 1 -4 3 1 9
Fax : 8 1 4 -7 9 3 -9 2 7 2
□
□
□
□
Br ow n in g
Car olin a
Mat t e r h or n
Cor cor an
ADDRESS INFORMATION
Billin g Ad d r e ss:
Co r p o r at io n Nam e:
St o r e Nam e:
St r eet Ad d r ess:
Cit y, St at e, Zip :
Co n t act Nam e:
Em ail:
Ph o n e Nu m b er :
Fax Nu m b er :
Sh ip To:
St o r e Nam e:
St o r e Nu m b er :
St r eet Ad d r ess:
Cit y, St at e, Zip :
Co n t act Nam e:
Em ail:
Ph o n e Nu m b er :
Fax Nu m b er :
ESERVICE INFORMATION
Nam e:
Cu r r en t ly Set Up : Yes o r No
Lo g in :
Passw o r d :
Em ail Ad d r ess:
SHIPPING INFORMATION
Please ch eck b o xes w h ich ap p ly (if o t h er p lease sp ecif y in b lan k sect io n s)
SHIPPING METHOD:
UPS
RPS
OTHER
PREPAID
COLLECT
OTHER
PAYMENT METHOD:
Co llect Acco u n t Nu m b er (s):
Ar e t r u ck sh ip m en t s allo w ed ?
Yes
No
Fr eig h t Car r ier :
Min im u m w eig h t r eq u ir ed f o r t r u ck sh ip m en t s?
ORDER INFORMATION
Please Cir cle On e:
Ear ly Sh ip m en t Per m it t ed ?
YES
NO
Backo r d er ?
YES
NO
PO n u m b er r eq u ir ed o n o r d er s?
YES
NO
Dep ar t m en t n u m b er r eq u ir ed ?
YES
NO
Dep ar t m en t #:
Ar e yo u cu r r en t ly d o in g b u sin ess w it h HH Br o w n ?
YES
NO
If yes, w h ich d ivisio n ?
SIGNATURES
Cust om e r :
Dat e
Sale s Re p r e se n t at iv e :
Dat e
Sale s Man ag e r Ap p r ov al:
Dat e
Ne w Accoun t n um b e r :
Dat e
* All Te r m s ar e n e t 4 5
* Or d e r m ust b e sub m it t e d w it h ap p licat ion
100Br
i
c
k
s
t
oneSq.St
e502,Andov
erMA01810
Phone:9789334700 Fax
:9784751
186