| Legal Business Name * |
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| Type of Business: * |
|
| D.B.A (if any): |
|
| FEIN# * |
|
| Company Address * |
|
| Suite/Floor/etc |
|
| City * |
|
| State/Province * |
Select a county / state...
|
| Country * |
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| Zip / Postal Code * |
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| Phone * |
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| Primary Contact Name |
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| Contact Number * |
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| Email * |
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| Purchasing Contact Name |
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| Purchasing Contact Number |
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| Purchasing Contact Email |
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| Resale Certification * |
Resale Certification must be
submitted to online@rgidistribution.com
to process new customer applications.
|
