Customer Information Request Form

Welcome to the Connect Work Tools Family! Get Connected. Stay Connected.

We’ve created this form to make placing orders and receiving invoices easy for you and a simple process for us.

Please take a moment to complete all the fields to help us collect the information we need.

Have questions about the form? Contact our team.

Billing Company Name

Billing Company Address

Billing Company City

Billing Company State

Billing Company Zip

Billing Company Country

Billing Company Phone

Billing Company Fax

A/P Contact First Name

A/P Contact Last Name

A/P Contact Email

A/P Contact Phone

Ship to Company Name

Ship to Company Address

Ship to Company City

Ship to Company State

Ship to Company Zip

Ship to Company Country

Ship to Company Phone

Ship to Company Fax

Ship to First Name

Ship to Last Name

Ship to Contact Email

Ship to Contact Phone

Do you have multiple ship-to locations?

Yes No Unsure

Ship to Company 2 Name

Ship to Company 2 Address

Company 2 City

Company 2 State

Company 2 Zip

Company 2 Country

Ship to Company 3 Name

Ship to Company 3 Address

Company 3 City

Company 3 State

Company 3 Zip

Company 3 Country

Ship to Company 4 Name

Ship to Company 4 Address

Company 4 City

Company 4 State

Company 4 Zip

Company 4 Country

Ship to Company 5 Name

Ship to Company 5 Address

Company 5 City

Company 5 State

Company 5 Zip

Company 5 Country

Ship to Company 6 Name

Ship to Company 6 Address

Ship to Company 6 City

Ship to Company 6 State

Ship to Company 6 Zip

Ship to Company 6 Country

Is a PO Number required for orders placed by your business?

Yes No

Should orders be held until the PO number has been received?

Yes No

Tax Status:

IMPORTANT: If your business is tax exempt or resale, exemption or resale certificate(s) that cover each ship-to location must be provided. If you have multiple locations, it may be easiest to send a multijurisdictional certificate listing all locations. Please note that we are required to charge the appropriate state's sales tax unless a copy of these certificates has been received prior to invoicing.

Are you outside of the United Sates?

Yes No

Customers outside of the United States, need to provide broker Information

Broker Contact Name

Broker Address

Broker City, State, Postal Code, Country

Broker Phone Number

Broker Fax Number

Broker Email Address

Company's Account Number

Form Completed By:

Title

Your Email Address

Date Completed

Customer Information Request Form

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