Custom Products New Customer Request Form

PO Box 609, Magnolia, AR  71754-0609
629 West Main, Magnolia, AR  71753-3594
Voice: (870) 234-7399 or (800) 365-5864
Fax: (800) 234-5180
Email: sales@customproductsaudio.com

Company Name:*
Type of Company: *
Billing Address:
E-mail:*
Phone:*
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Fax:
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Owners Name:
State Sales Tax I.D. Number:*
Briefly describe the nature of your business:
List your three major suppliers of merchandise:*
List Three Credit References: *