New Customer Account Setup Form

ACCOUNTS PAYABLE INFORMATION
Customer Name*
A/P Contact Name*
A/P Phone Number*
A/P Email Address*
BILLING AND INVOICE INFORMATION
Email Address for Invoices*
PO Number Required
- Yes
- No
Tax Exempt
- Yes
- No
(If yes please provide copy of tax-exempt form)
Tax Exempt Form
Max. file size: 300 MB.
Company Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
ACH INFORMATION
Bank: Truist Routing # 021052053 Account # 25132734 EIN: 58-1090239 Address: P.O. Box 1309, Alpharetta, GA 30009 Email: ar@procheminc.com Phone: 770-740-2800
Please include invoice # on remittance payment

ACCOUNTS PAYABLE INFORMATION