New Customer Form

Thank you for your interest in Adapter Resources. We’re eager to help you. Please fill out our New Customer Form below, click the submit button and we’ll take it from there. For your convenience you can include your credit references on the form, or you can email them to: or you can fax them to the attention of JoAnn Popella at: 888-832-5539. Thank you, we look forward to building a relationship with you.

  1. Company
  2. (required)
  3. Company Billing Address
  4. (required)
  5. (required)
  6. (required)
  7. (required)
  8. Ship To Address. If the shipping address is the same as the billing address, check the box below and leave the shipping address fields blank
  9. Company Contact Info
  10. (required)
  11. (required)
  12. (required)
  13. (required)
  14. (required)
  15. I would like my invoices
  16. Preferred Shipping Method
  17. Please provide us with a copy of your Tax Exempt Form and Credit References.
  18. Credit Reference #1
  19. Credit Reference #2
  20. Credit Reference #3

cforms contact form by delicious:days

Get Adobe Flash player

Warning: Unknown: open(/home/104682/data/tmp/sess_54b85638f3e1e2ecbe3061068da65dfd, O_RDWR) failed: Disk quota exceeded (122) in Unknown on line 0

Warning: Unknown: Failed to write session data (files). Please verify that the current setting of session.save_path is correct (/home/104682/data/tmp) in Unknown on line 0