Barger Packaging : New Customer/Credit Application Form

Required fields are in bold.

Bill To: Company Name
Address
Main Phone
Fax

Primary Ship To Information Same as Bill To
Address
Phone
Fax

Owners/Officers Name
Title

Name
Title

Company Details

Company Type

Corporation
Partnership
Sole Proprietorship

Tax Exempt #
Upload Tax Exempt Certificate

(click on button above to attach file)

Upload Credit and Bank Information Upload Word Document or PDF

If no file is uploaded, you must supply a bank reference and at least one credit reference below.

Bank Reference Bank Name
Account #
Address
Phone
Fax

Credit References Company Name
Address
Phone
Fax
Company Name
Address
Phone
Fax

A/P Contact Info Name
E-mail
Same as Bill To
Address
Phone
Fax

Purchasing Contact Name
E-mail
Same as Bill To
Address
Phone
Fax

Quality Contact Name
E-mail
Same as Bill To
Address
Phone
Fax

Shipping Details

(all shipments will go collect)

Preferred Small Parcel Carrier

UPS
FedEx
DHL
Other:

Small Parcel Carrier Account #
Special Shipping Instructions
Preferred Freight (LTL) Carrier
Freight Carrier Account #

Submitted By: Name
Title
Date

If you are have any questions filling out this form, please contact Customer Service at 888-525-2845