Business Account Request Form

* denotes required field

Company Name*
Mailing Address*
Zip Code*
Contact Name*
Contact Title*
Contact Email Address*
Contact Area Code & Telephone Number*
Do you have a resale certificate?*
State Resale Number
Federal Tax ID Number
What type of account are you looking to establish?*
Business Description*
If Other, please describe
Business Description99999 characters remaining
Tell us about your store & location
Store Description99999 characters remaining
How did you hear about Baxter Bailey & Company?
How did you hear about us?99999 characters remaining
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