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CUSTOMER INFORMATION FORM
First Name
Main Email
Accounts Payable Email
Last Name
Main Phone Number
Job Title
Street Address
Street Address Line 2
City
Zip code
State/Province
Country
Account Type
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Wholesale
Retail
Rep Name
Payment Method
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Cash
Check
Credit Card (3.75% Service Fee)
Resale Number
Upload Resale Certificate
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Resale Certificate Number (Submit copy to your Rep or Email to levelwaterco@gmail.com) Please note you will be charged tax if we do not have Resale Certificate on file
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