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Dr. Barbara Sturm Customer Setup Form
This form will be forwarded directly to the brand. Please complete with that in mind and be as detailed as possible.
PLEASE INCLUDE:
Your resale certificate
Your completed brand contract (emailed to you)
Please enable JavaScript in your browser to complete this form.
Account Name
*
bill to address
Store / Location #
*
Address Line 1
*
Address Line 2
City
*
Zipcode
*
State
*
Territory
*
USA
Canada
ship to address
Name
*
Address Line 1
*
Address Line 2
City
*
Zipcode
*
State
*
Territory
*
USA
Canada
primary contact
Name
*
Email
*
billing contact
Name
*
Email
*
Resale Number
*
COPY OF RESALE CERTIFICATE
*
Click or drag a file to this area to upload.
Invoice Terms
*
Invoice Terms
Credit Card
Shipment Terms
Customer assumes all shipping expenses
UPS/FedEx Account #
*
SIGNED AND FILLED BRAND CONTRACT
*
Click or drag a file to this area to upload.
I have filled out the credit authorization form
Submit
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