New Client Form

Please fill out the form below with as much information as you can provide. If you are unable to use the form below, there is a downloadable version at the bottom of this page. Simply fill out the .pdf and email to [email protected], or fax to 225-208-1707.

Type of Business

Proprietorship

Partnership

Corporation

Name of Business

Billing Address

City

State

Zip Code

Shipping Address (if different from above)

Phone

Fax

Years in Business (reply "new business" if less than 1 year)

Are you sales tax exempt?

Yes

No

If yes, please provide sales tax exempt number

List Owners (first name, last name, and date of birth)

Name and address of at least 3 businesses (new businesses provide as many as possible) from whom you are presently purchasing on a charge basis. Credit card company and loan company not acceptable. Please give us references that you buy from on a regular basis.

The information that I have provided in this new client form is current and accurate.

Our Privacy Policy applies.

Note: Please fill out the fields marked with an asterisk.

Parker Brand Creative Services - New Client Form

Please fill out this form to the best of your ability, then email or fax to our office.

NEW Client Form.pdf

Adobe Acrobat Document 148.3 KB

Download

New Client Form

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