Thank you for your interest in Laminart. Please take a moment to complete this customer profile. Account information submitted on this form will remain confidential and be used for the sole purpose of communicating with you. Under no circumstances does Laminart sell or disclose personal information to third parties. We appreciate your interest in Laminart’s premium decorative surfacing materials and we look forward to doing business with you.

Company Information

Company Name*
Street Address 1*
Street Address 2
City*
Country*
State/Province*
ZIP/Postal code*
Phone*
Fax
Website

Billing Address

Same as Company Address
Street Address 1*
Street Address 2
City*
Country*
State/Province*
ZIP/Postal code*

Shipping Address

Same as Company Address
Street Address 1*
Street Address 2
City*
Country*
State/Province*
ZIP/Postal code*

Tax Information

Is your business exempt from sales tax?*
YES    NO
( if yes, please Fax or Email a copy of Tax Exempt certificate to our offices - 847.860.9199 )

Purchasing Contact

Name*
Title*
Phone*
Fax
Email*

Accounting Contact

Name*
Title*
Phone*
Fax
Email*

Employee/Business Information

Number of Employees:
less than 10
10-25
26-50
50 or more
Primary Business:
Retail
Hospitality
Office
Healthcare
Education
Transportation
Residential
Other

Preferred method of payment:

Credit Card ( Visa, Mastercard and American Express only )
Net 30 ( credit request application available below when this option is selected )
(please complete and submit this credit application)

Trade Reference

Please list trade references with whom you have been buying on open account for no less than six months. Four are required for processing. Please include fax and account numbers.

Trade Reference 1

Company*
Acct#*
Address*
City*
Country*
State/Province*
ZIP/Postal code*
Phone*
Fax*

Trade Reference 2

Company*
Acct#*
Address*
City*
Country*
State/Province*
ZIP/Postal code*
Phone*
Fax*

Trade Reference 3

Company*
Acct#*
Address*
City*
Country*
State/Province*
ZIP/Postal code*
Phone*
Fax*

Trade Reference 4

Company*
Acct#*
Address*
City*
Country*
State/Province*
ZIP/Postal code*
Phone*
Fax*
Please Note: Laminart does not send monthly statements. Invoices are mailed to the accounting email address this is provided on customer profile form.
Company acknowledges and agrees that Laminart’s payment terms are “Net 30 days from date of invoice.” Company also acknowledges responsibility for any and all collection fees, interest, attorneys’ fees, or other additional charges incurred due to collection action(s).
Name*
Title*
Email/Signature*