New Customers "*" indicates required fields Club/Account Name* Club/Account PhoneClub/Account FaxPhone*Email* Tax Exempt Yes No Exempt# Upload Your Exempt Certificate HereMax. file size: 20 MB.Billing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping Address NotesGames of Chance AccountGOC License# Upload Your Games of Chance Form (GC5)Max. file size: 20 MB.Purchasing Contact PhoneEmail Dispenser Make/Model Special Event Date(s)Seal Cards Type/Count Preferred Current Supplier(s) NotesBingo AccountBingo License# Copy of FormMax. file size: 20 MB.Purchasing Contact PhoneEmail Equip Make/Model Day/Time of Game MM slash DD slash YYYY Ave Attend Hard Boards Yes No Sheet Attached Yes No Paper Type Extra Paper Ups Ons Current Supplier(s)NotesNovelty AccountPurchasing Contact PhoneEmail Ink Brand(s)Size(s)Other ItemsCurrent Supplier(s)NotesCommentsThis field is for validation purposes and should be left unchanged. Download the Charitable Tax Exempt Form if Applicable
