Huxley & Kent Customer Application

Business Information:

*Retailer Name

*Telephone Number

Fax Number

*Website Address

*Billing Address

*City

*State

*Postal Code

*Number Of Store Locations

Shipping Information:

*Shipping Address

*City

*State

*Country

*Postal Code

Contact Information:

*Owner's Name

*Owner's Email

Owner's Telephone Number

*Buyer's Name

*Buyer's Email

*Buyer's Telephone Number

*Buyer's Title/Position

Company Information:

*Federal Tax ID

*State Tax Exempt #

Year Established

Number Of Employees

*Type Of Business

*Business Location Type

Comments Or Questions:

Please add any comments or questions for us here

*How did you hear about us?

*Please let us know how you heard about us.

Huxley & Kent Online Ordering

After your account is approved, would you like to have us activate your online ordering account? Once activated, you will receive an email containing the site’s address, your login and password.

Yes

Signature:

All products offered for sale purchased from Huxley & Kent will adhere to Huxley & Kent’s pricing policy. Any special promotions involving products acquired through Huxley & Kent must be pre-approved by Huxley & Kent. Failure to comply with this pricing policy may result in the termination of your vendor account. By checking the box and initialing below, I understand and accept the above condition(s) and can verify that all of the above information is true to the best of my knowledge.

Review Pricing Policy

I verify the above information and accept the above terms

Yes

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