Fill out the form below (you must attach a scan of your state issued Tax Certificate), or print this PDF form and fax the information with your Tax Certificate to (817) 861-1115. We will check for conflicting accounts in your area and email a catalog.

Acceptable formats for Tax Certificate are: PDF, JPG, TIFF & PNG.
Maximum filesize is 6 megabytes.

Your name *
Your title *
Company Name *
Business Type *
E-Mail *
Phone *
Fax
Address *
Website
How'd you hear about us? *

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Fax and website address are optional. * are required fields. Separate address for billing and shipping can be setup with your first order - indicate the physical business address above as listed on your tax certificate.

Please allow 2-5 business days for a response.

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