NEW CUSTOMER SETUP FORM

http://
Phone *
Phone
Fax *
Fax
Ship To Address *
Ship To Address
Shipping Contact *
Shipping Contact
Shipping Contact Phone *
Shipping Contact Phone
Billing Address
Billing Address
If different than shipping address
Purchasing Agent Name *
Purchasing Agent Name
Purchasing Agent Address
Purchasing Agent Address
Purchasing Agent Phone
Purchasing Agent Phone
if applicable
if applicable

Credit Card Authorization Form

We request that all customers who wish to purchase and/or pay invoices by credit card, please fill out the form below. Your cooperation will be greatly appreciated. Unfortunately we are unable to process any credit card payments until this form is filled out.

Company Address *
Company Address
Expiration Date *
Expiration Date
found on the back of the card
if different than above
Check One *
Name on Card *
Name on Card

Private Label Information Form

In order for ArroChem, Inc. to private label for your company, we will need this form completed. The information below is what will appear on your product label, Material Safety Data Sheet, Bill of Lading for freight and packing list to your customer (copy of BoL). If you have any questions in regards to private labeling please let us know.

Address *
Address
Must be a physical address
Phone *
Phone
Toll-Free Phone
Toll-Free Phone
if applicable
Fax
Fax
http://
24-hr Manned Emergency Phone Number
24-hr Manned Emergency Phone Number
required for hazardous materials
required for hazardous materials
we recommend the following three companies:
Labeling *
ArroChem will generate a private product label
Input your initials upon verifying the above is correct and accurate