*	Company Name
	Attention
*	Mailing Address
	Apt, Suite, Floor
*	City
*	State
*	Zip
*	Main Telephone
	Fax Number
	Email Address
	Existing Customer	No   Yes  Account #
*	Business Type	Retail   Manufacturer   Wholesale
	JBT Rated	No   Yes  Rating
*	Owner's Name
	Buyer's Name
	Bookkeeper's Name
	Multiple Branches	No   Yes  (Requires Separate Forms)