If you are interested setting up an account with us, or one of our staff has directed you to this page, please fill out the form below and click the “submit” button. We will look over your information and be in contact with you as soon as possible.

Alternatively, you can download the form here. Once completed, fax the completed form at (559)-688-6610. We will be in contact with you as soon as it has been reviewed.

• NEW CUSTOMER ACCOUNT INFORMATION / CREDIT APPLICATION

• COMPANY INFORMATION

• Company Name
• TAX ID #
• Billing Address
  Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• • Shipping address is same as billing address
• Shipping Address
  Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Phone
• Cell
• Fax
• Ownership
  • Corporation
  • Partnership
  • Proprietorship
• Years in Business

• Principle Owners and/or Stockholders name:	Address

  To add more owners, please click the 'plus' symbol

• BANKING INFORMATION

• Bank Name
• Account #
• Contact Name
• Phone
• Fax
• Address
  Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

• TRADE REFERENCES

• 1. Name
• Trade Ref. 1. Address
• Phone
• Fax*
• 2. Name
• Address
• Phone
• Fax*
• 3. Name
• Address
• Phone
• Fax*
• 4. Name
• Address
• Phone
• Fax*
• Are you purchasing under the California Sales Tax Ag Exemption?
  • Yes
  • No
  If "Yes" you must have a signed exemption form on file in our office before you make your purchase.
• Resale Accounts. Are you a resale account?
  • Yes
  • No
  If "Yes", please return a signed resale card and provide the information below:
• Firm Name:
• Permit No:

• I hereby certify, that the above entity or individual holds a valid sellers permit number as given above. I also certify that the tangible personal property described below, which I shall purchase from Cal State Distributing, Inc., will be sold in the form of tangible personal property. I understand that in the event any such property is used for any purpose other than retention, demonstration or display while holding it for sale in the regular course of business, the reseller is required by the Sales and Use Tax Law to report and pay for the tax measured by the purchase price of such property.
• Describe property to be purchased
• Signature*
• Date