If your company is interested in establishing an account with Wire Supplies Inc., please complete and submit the form below for approval. Name of Company Ship to Address City State - Zip Code Bill to Address City State - Zip Code Phone Fax D&B Number Tax ID Number Federal ID Number Year Started Owners, Partners Officers Accounts Payable Contact Name Address City State - Zip Code Phone Fax Contact Account Number Name Address City State - Zip Code Phone Fax Contact Account Number Name Address City State - Zip Code Phone Fax Contact Account Number Name Address City State - Zip Code Phone Fax Contact Account Number Your Title Email Address Printed Name Date I/We agree to the Wire Supplies, Inc. Terms and Conditions of Sale Questions or Comments