3817 West Main Street, Batavia, NY 14020 • (800) 666-8950

New Account Setup - Online Form

Fields marked with * are mandatory.

* Your Name
* Your E-Mail Address

* Company Name
* Billing Address
* Shipping Address
* Phone		Fax

* Company Type	Individual	Partnership	Corporation

Who will be our contact for questions about orders?
* Name		* Phone
* E-Mail Address

Who is responsible for paying your bills?
* Name		* Phone
* E-Mail Address

* Would you like to receive invoices/statements via email?
	Yes	No
E-Mail Address

* PO required?	Yes	No
If yes, does each PO need a separate invoice?
	Yes	No

We normally ship UPS ground or US Mail. Please note if other arrangements are required:

* Would you like tracking numbers sent to your email upon shipment of packages?
	Yes	No
E-Mail Address

Who is the owner/president of your company?
* Name		* Phone
* E-Mail Address

How did you hear about our company?
Trade Show	Which Show?
Magazine Ad	Which Magazine?
Referral	Who may we thank?
Direct Mail	Other

Which of our products do you currently purchase from any source?
Business Cards		Engraved Signs
Rubber Stamps		Hot Stamping / Printing Dies
Labels		Letterheads / Envelopes
Notary / Corporate Seals		Genuine Engraving

I acknowledge I have read the Hodgins Engraving Co., Inc. Credit Policy and agree to pay accordingly.
* Name		* Date

* Do you have any credit references to provide?
	Yes	No
Credit Reference 1
Company Name
Billing Address
Phone		Fax
Contact Person
E-Mail Address
Credit Reference 2
Company Name
Billing Address
Phone		Fax
Contact Person
E-Mail Address
Credit Reference 3
Company Name
Billing Address
Phone		Fax
Contact Person
E-Mail Address