Vendor Application complete the following information
               
               AcuAids
                100 Kreps Rd
               North Lima, Ohio 44452
                330-549-2146
Your name:
Business Name
Business Address
Shipping Address if
different from Business Address
Phone number:
Your email address:
Fax Number
Taxpayer ID#
Resale Tax number
Partnership?
Corporation?
Sole Proprietorship?
How Long has customer been in business
Vendor Application

Customer Acknowledges and warrants that the above information on the application is true and may be relied upon
by AcuAids. Payment for all items ordered is due at the time of order.  
Comments: