D&H New Customer Signup

New Customer Signup

Fields marked with * are required.

Note: If you are unable to complete your application in one session, you will be able to return to the online application and complete it from where you left off. In order to do so, you must use the same computer and have your cookies enabled.

Basic Company Information

Legal Business Trade Name

D.B.A.

Street Address

Address Line 2

City

State

Zip

Phone Number

( ) -

Fax Number

( ) -

Email Address

Web Site

Billing Information

A/P Contact First Name

A/P Contact Last Name

The A/P Contact First Name and Last Name may not exceed 34 characters.

Phone Number

( ) -

Email Address

Billing Address

Address Line 2

City

State

Zip

Shipping Information

Shipping Contact First Name

Shipping Contact Last Name

The Shipping Contact First Name and Last Name may not exceed 34 characters.

Phone Number

( ) -

Email Address

Shipping Address

Address Line 2

No P.O. Boxes; for multiple locations — attach a sheet to the form when submitted by fax or mail.

City

State

Zip

Is your billing address different than the above address?

Is your shipping address different than the above address?

Province

Exempt?

Reg. Number

You have already entered information for this province. Duplicates are not permitted.

Please select a Province.

Please enter the EHF/ADF number for this province.

Your application is complete

Application Progress

1

Basic Company Information
- Legal Business Trade Name
- D.B.A.
- Street Address
- City
- State
- Zip
- Phone Number
- Fax Number
- Email Address
- Web Site
1a

Billing Information
- A/P Contact First Name
- A/P Contact Last Name
- Phone Number
- Email Address
- Billing Address
- City
- State
- Zip
1b

Shipping Information
- Shipping Contact First Name
- Shipping Contact Last Name
- Phone Number
- Email Address
- Shipping Address
- City
- State
- Zip

Landlord/Mortgage Information

Business Information

Principal Information

Bank References

Credit and Shipping Information

Authorized Buyers

Web Agreement

Summary

Please complete the required fields of the application before proceeding to the next step.