New Customer Profile Form

Thank you for your interest in our product line.  To become a customer and join our E-Business Interactive Order Processing and Information System Website we ask that you please fill out this form.

 

When you place your first order online and become a new Natico customer we will contact you for some additional information and request that you fax us a copy of your Resale/Tax Id Certification to us at (212) 779-8931.

 

The Asterisk (*) Represents Required Information {Must Be Enter Before Submission....}

 

* Company Name:

 

 

* Bill to Address
Street Name:
Additional:
City:
State: Zip:
Country:

 

Ship to Address (if different from the above)
Street Name:
Additional:
City:
State: Zip:
Country:

 

 

 

Salutation:

 * First Name: *Last Name:

    * Administrative Function:

* Phone Number:

 Ext.: *Fax: (Type NoFax if none)

* Email Address:

Website Address:

*Requested User ID:

(max. 15 characters and must be Alphanumeric)

 
Type of Business:  Please check all that apply  

    Corp. Gift 

         

      

 

 

* Preferred Method of Payment:  

Note: For Net 30 Terms - Please submit on your Company Letterhead the Names, Addresses, Phone & Fax Number of Five (5) Trade references along with your Bank information and fax it to us at (212) 779-8931.

 

* What types of products do you sell?

 

 

 

 

 

If Additional "Users" are needed Please contact us via email customer_service@natico.com

 

Thank you for taking the time to fill out this form. A “Member” user ID and password will be emailed to you shortly.  You will receive a "Customer" user ID and password after you place your first order.  We look forward to hearing from you!