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Date:

SKG Salesperson/Contact:

Tax Exempt? YesNo

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Client & Company Information

Company Name:

DBA:

Business Address:

City:

State

Zip Code:

Contact Name:

Email:

Phone:

Alt Contact Name:

Alt Contact Phone:

Installation Address

Same as business address above

Project Name/Installation Site Name:

Address:

City:

State

Zip Code:

Receiving Contact:

Email:

Phone:

Additional Receiving Info:

Accounts Payable Address & Contact:

Same as business address above

Address:

City:

State

Zip Code:

AP Contact:

Email:

Phone:

Remit to Contact:

Email:

Phone:

Is a Customer Purchase Order Required? YesNo

Will Product Be Shipping Out of State? YesNo

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Client & Company Information

Installation Address

Accounts Payable Address & Contact:

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