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: joann@adapterresources.com 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
 

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