Customer Registration – Kos Distribution

CUSTOMER REGISTRATION FORM

Thank you for your interest in Kos Distribution! Please fill out the form below to become a customer.

BUSINESS NAME

BUSINESS TYPE (RETAIL, WHOLESALE, RESTAURANT, ETC.)

BUSINESS LICENSE NUMBER

WEBSITE

BUSINESS ADDRESS

City

State

ZIP Code

Country

PRIMARY CONTACT INFORMATION

Contact Name

Job Title

Phone Number

ACCOUNT INFORMATION

Preferred Payment Method (Credit, ACH, Net Terms, etc.)

Estimated Monthly Purchase Volume

Products of Interest

DELIVERY & LOGISTICS

Do you require delivery?
YesNo

If yes, preferred delivery days/times:

Do you have a loading dock?
YesNo

ADDITIONAL INFORMATION

How did you hear about Kos Distribution?

Are you interested in promotional or marketing support?
YesNo

Any additional comments

AGREEMENT & SUBMISSION:
By submitting this form, I confirm that the information provided is accurate and that our company complies with all regulatory requirements.

CUSTOMER REGISTRATION FORM

CUSTOMER REGISTRATION FORM

CUSTOMER REGISTRATION FORM

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