Signup - Valley Industries Corporation

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New Customer Information Form

Thank you for your interest in Valley products. For you to open a direct account with Valley Industries we require this completed form with one of the following business documents to be faxed back to use.

California Accounts must provide a valid California resale permit. For permits issued under a personal name, we will also require a valid business license.

Out-of State Accounts will require a valid business license or a resale permit issued by the state. But if the resale permit is issued under a personal name, then a valid business license will also be required or a Federal Employment Identification Number (FEIN).

Company Name*

Date*
MM slash DD slash YYYY

Mailing Address*

City*

State/Province*

Zip/Postal Code*

Country*

Contact Person*

Telephone*

Mobile

E-mail*
Enter Email Confirm Email

Username*

Password*
Enter Password Confirm Password

How did your hear about us?*

Are you a Retailer or Wholesaler?*

How many locations?*

If you are a Retailer, what type of store do you have or if a Wholesaler which types of stores do you service? (Please check all that applies)*
Traditional Hardware
Home Center
Automotive
Farm/Agriculture
Variety
Industrial Supply/MRO

Do you sell on the internet?*

What is your website?*

Do you stock product?*

Do you need drop shipping?*

Please list your current tool suppliers:*

What is your approximate import tool volume for last year ($)?*

Email
This field is for validation purposes and should be left unchanged.

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