Your Name: Title:

Name of Business: DBA:

Phone: Fax: Email: Website:

Contacts Orders: Contacts Accounting: Email Invoice Y/N Email to:

Billing Address: Must Include Resale Tax Exempt Certificate with this form.

Shipping Address: Legitimate retail location Y/N: Are there are multiple locations Y/N: If yes, submit a complete list.

Special order/Shipping Instructions:

Can account accept truck shipments Y/N: If yes, do they require Delivery Appt. Y/N: Liftgate Service Y/N
Type of Store:
Toy Gift Museum Book Pen Educational Stationery Art Craft

Custom Department Mass Luggage Jewelry Specialty Office Scrapbook *Other

*Other Explain:

Type of Business:
Catalog Chain Franchise Export
Independent Internet Distributor *Other

*Other Explain:

Bank Information:

Name:

Contact: Email:

Phone: Fax:

Sales Representative: Art & Graphic Pricing Structure: Date:

ALL INFORMATION MUST BE RECEIVED BEFORE ORDER IS PROCESSED

A.W. Faber-Castell USA, Inc. ● 9450 Allen Drive, Suite B ● Cleveland, Ohio 44125 ● info@fabercastell.com
Toll Free: 800-642-2288 ● Phone: 216-643-4660 ● Fax: 216-643-4664
www.fabercastell.com