NEW ACCOUNT FORM

*Account information is required. Tax forms are optional.

1Account
2Tax form
3Sign

Account information

Company Name: *

Billing Address: *

Street Address Street Address Line 2

City State / Province Postal / Zip Code

Shipping Address: *

Same as billing address

Street Address Street Address Line 2

City State / Province Postal / Zip Code

Phone Number: * Format: (000) 000-0000.

Name *

First Name Last Name

Email address: *

A/P Contact: *

First Name Last Name

Delivery Hours (include Friday): * Need a lift gate? * Payment method: * Method only, such as check or credit card. Do not enter card numbers or bank details.

If you need help, call or message me at 329-300-6129 or email shaya@bcpkg.com.

Thank you! Orders Department

NEW ACCOUNT FORM

B&C Industries

Review & sign

Thank you!