Preferred Buyer Plan Order Form

There are no annual fees and no minimum purchases required for this type of account

*Company Name:
*Street Address:
*City:		*State:
*Postal Code:		*Country:
*Phone Number:		*E-mail Address:
*Name of Purchasing Contact:		*Name of Billing Contact:
Does your business have a store front?		Yes

Please provide us with a brief profile and description of your business:

-You will be contacted shortly for activation of your account-

*ALL FIELDS REQUIRED

Please do not hesitate to give us a call with any questions that you may have.

(xxx)-xxx-xxxx