New Customer Application

 

New Customer Application

 

If you are new to Laser Valley, or have not done business with us in the past 2 years, please complete the form below to help us process your orders quickly and efficiently. You will be contacted shortly and we will provide you with credentials to log into the website and place orders.
All New Customers will receive $20 in Laser Bucks that can be applied to a future order

 

* indicates a required field.

Company Information

Is there more than one location? *
YES NO

COMPANY NAME: *

ADDRESS: *

CITY: *

PROVINCE: *

POSTAL CODE: *

PHONE: *

FAX: *

TYPE OF BUSINESS: *

COMPANY PRINCIPAL/OWNER: *

YEARS IN OPERATION: *

WHERE DID YOU HEAR ABOUT US?: *

Contact Information

Cartridges

CARTRIDGE PURCHASER CONTACT: *

CARTRIDGE PURCHASER EMAIL: *

CARTRIDGE PURCHASER PHONE: *

CAN SEND YOU OUR MONTHLY NEWSLETTER ABOUT SPECIALS AND NEW PRODUCTS?:*
YES NO

Printers
Same as Cartridges

PRINTERS/SERVICE CONTACT: *

PRINTERS/SERVICE EMAIL: *

PRINTERS/SERVICE PHONE: *

CAN SEND YOU OUR MONTHLY NEWSLETTER ABOUT SPECIALS AND NEW PRODUCTS?:*
YES NO

Payables
Same as Cartridges
Same as Printers

PAYABLES CONTACT: *

PAYABLES EMAIL: *

PAYABLES PHONE: *

CAN SEND YOU OUR MONTHLY NEWSLETTER ABOUT SPECIALS AND NEW PRODUCTS?:*
YES NO

Shipping Address Same as Above

SHIP TO COMPANY NAME: *

SHIP TO ADDRESS: *

SHIP TO CITY: *

SHIP TO PROVINCE: *

SHIP TO POSTAL CODE: *

SHIP TO PHONE: *

SHIP TO FAX: *

PAYMENT INFORMATION

PAYMENT PREFERENCE *
TERMS (net 15)

CREDIT CARD

ELECTRONIC MONEY TRANSFER (EMT)

You will be invoiced with terms of Net 15
INVOICING PREFERENCE: *
MAIL

EMAIL