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Cannon IV Marketplace - Sign-Up - New Customer Credit Application

Thank you for choosing to open an online store account with Cannon IV! Please complete the form below at thoroughly as possible to expedite the review process. Incomplete applications will be rejected.

*Denotes a required field

1. Company and Billing Information
*Company Name:
*Billing Address:
*City:		*State:	*ZIP:
County:
*Phone:
Fax:
Owner of Company:
*Select one:	Individual/Sole Proprietor Corporation Partnership

2. Accounts Payable contact information
*Name:		*Phone:
*Title:
*Email:
Tax Exempt#:		(if applicable)
Federal ID#:
D & B#:

3. Authorized purchaser contact information
*Name:		*Phone:
*Title:
*Email:

4. Trade references
*Company 1:
*Phone:		*Fax:
Account #:		Contact:

*Company 2:
*Phone:		*Fax:
Account #:		Contact:

*Company 3:
*Phone:		*Fax:
Account #:		Contact:

(800) 825-7779