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General Information
*
Select Product Type
Trash Bags/Can Liners/Sheeting
Cups/Containers
Closures/Bottles/Tubes
Films - Agri/Custom/Food/Stretch
Tapes/Adhesives/Corrosion Protection
Heath,Hygiene,Spec Nonwovens/Films/FIBC
Company Information
*
Business Name
Doing Business As (DBA Name)
*
Physical Address
*
City
*
State/ Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
*
Zip/Postal
Country
United States Of America
Canada
Telephone - Work
Fax Number
Email Address
Business Website
*
Application Contact Name
Federal Tax ID
*
Sales Tax Exempt ?
Yes
No
*
Is your business EDI Capable?
Yes
No
*
Orders Submitted How?
EDI
Email
Fax
Portal
Company Financials
Income Statement
Net Sales
$
Attachments
Please attach documents relevant to the application decision process (i.e., company financials, relevant license information, etc)
Attachment Description
Attachment Location
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Upload
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Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.
Terms and Conditions
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Signature of Applicant
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Title
*
Date
PRINT AGREEMENT
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I agree to the terms and conditions specified above.
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User Verification
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