New Customer Information Form

FAX TO: 732-364-3253

or

MAIL TO: Harold Import Company

747 Vassar Avenue

Lakewood, NJ 08701

IN ORDER TO EXPIDITE THE CREATION OF YOUR HIC ACCOUNT, PLEASE PROVIDE US WITH AS MUCH INFORMATION AS POSSIBLE.

IF YOU HAVE ANY QUESTIONS, PLEASE CALL US AT 800-526-2163. ANY CUSTOMER SERVICE REP WILL BE HAPPY TO HELP YOU.

Please attach credit sheet where applicable. Thank you.

Business Name _________________________________________________ (REQUIRED)

Mailing Address _________________________________________________ (REQUIRED)

_________________________________________________

Shipping Address _________________________________________________ (REQUIRED)

_________________________________________________

Phone (Business) _________________________________________________ (REQUIRED)

Phone (Cell) _________________________________________________

Fax _________________________________________________

E-mail Address _________________________________________________

Website Address _________________________________________________

Owner – Name _________________________________________________ (REQUIRED)

Buyer – Name _________________________________________________(REQUIRED)

Type of Business

(briefly describe) _________________________________________________

_________________________________________________

Wholesale/Retail _________________________________________________

How did you hear about Harold Import Company?

(Ex. HIC Sales Rep, Customer Recommendation/Word of Mouth, Tradeshow/Trade Event, Industry Ads/Press, Web Search, etc.)

__________________________________________________________________________________________

__________________________________________________________________________________________

Would you like us to mail you the current HIC catalog and pricelist ? Yes No

Would you like to be signed up to receive the electonic HIC E-News? Yes No
This newsletter is distributed weekly - to see archived editions, go to the "What's New" section of our website.
IF SIGNING UP FOR THE HIC E-NEWS, PLEASE MAKE SURE THAT WE HAVE YOUR E-MAIL ADDRESS.

PAYMENT INFORMATION (REQUIRED)

Accounts Payable Contact – Name _________________________________________________ (REQUIRED)

Accounts Payable Contact – Phone _________________________________________________ (REQUIRED)

RESALE TAX ID# _________________________________________________ (REQUIRED)

Method of Payment (Please Check One) _____ COD (with certified check or money order only)

(REQUIRED) 

_____ Check payment in advance

_____ Other (Please attach your credit sheet.)

_____ Credit Card (Fill out appropriate information below.)

Credit Card Type: ___ VISA

___ Mastercard

___ American Express

___ Discover

Credit Card #: _________________________________

Exp. Date (Month, Day, Year) _____________________

Credit Card Billing Address _______________________

______________________________________________

______________________________________________

Do you have any special information or instructions that you would like us to note in your account?

(Ex. Shipping instructions, backorder procedures, alternative contact information, etc.) If yes, please describe.

Thank you.

___________________________________________________________________________________________

___________________________________________________________________________________________

Once we have received and verified your information, we will contact you with a HIC account number and an online password for wholesale ordering. Under normal circumstances, you can expect to be contacted within two business days of receipt.

Thank you again.