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Address:*

Address2:

City:*

State/Province:*

Zip Code:*

County:*

Billing Same As Shipping

Is This Product For Export

If So What Country:

Market Segment:*

Export Letter Supplied

Credit Application Sent / Attached

Tax Exempt Status(check one): Canadian Tax 677(PST & GST) 678 (GST Only, Supply PST) Non-Taxable Taxable

Tax Exempt Number: If the certificate is not received, the customer will be set-up as taxable.

Certificate Attached

This field is only applicable to the mays landing location at this time. Carrier:

Mode:

Service:

Invoice method(if other than normal mail): Email:

Fax:

SDS Email Address:

Should the SDS sheets be mailed to Ship-to address or to the Bill-to address(check one)?:*

Ship-To Bill-To

Requestor:

Upload Document(s): Allowed file size is 20 MB and file extensions are .docx and .pdf

Only file extensions doc,docx,pdf,png,xls are accepted.

File size should not be more than 10 MB

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