Customer Account Creation Request

*This Request is for:

*Account Manager

*Customer's Account Name

*Company's Name

*Address:

Street Address Line 2:

*City:

State/Department:

Zip Code

*Country:

*Phone Number:

Billing Address:

City:

State/Department:

Zip Code

Country:

Phone Number:

*Consolidator

Company Elite Flower Services Inc

*Sale Type

*Payment Terms

Entrega

Empaque

*Shipping Type

*Invoice Format

The fields below should have the information of the person making this request. Please field accordingly

*Name:

*Email:

Phone Number:

Ext Number: