Customer Information Form – Bay Area Diesel

Customer Information Form

Company Name

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Cellphone Number

Company Contact Name

First

Last

Contact Email Address

Position/Title

Accounting Info

Company Contact Tax

Accounting Contact Name

Accounting Contact Email Address

Tax Exempt?

Yes
No

If yes, we will need Tax ID and a copy of tax exempt certificate.