Customer Registration

Section 1: Business & Shipping Information

Company Name: 

Tax ID/EIN: 

Phone No: 

DUNS No: 

Website Address: 

Tax Registration Number: 

Entity Type (Corporation, LLC, Sole Proprietorship, Other):

VAT / GST No: 

Billing Address (Hard copies of invoices will be delivered to this address):

Shipping Address (If different than Billing Address):

Street/PO Box:
City:
State/Province:
Zip/Postal Code:
Country:

Street:
City:
State/Province:
Zip/Postal Code:
Country:

Section 2: Company Contact Information

Contact Name

Phone

Email

Buyer Contact Name: 

   

Accounting Contact Name: 

   

Electronic Billing Contact Name: 

   

Order Acknowledgements Name: 

   

Section 3: Payment Terms

I wish to pre-pay my order(s)

I request net 30 days payment terms

Requested credit limit: 

Additional requests/comments:

 

Default Currency

* By submitting this application form you agree to RealWear’s Terms of Service , Privacy Policy, and those within the RealWear End User Guide. Applicant acknowledges that RealWear, Inc. may use a business credit report in the decision to extend credit. RealWear, Inc. may also require that supplemental financial information, such as audited financial statements, be provided to aid in the determination of creditworthiness. Submittal of application does not constitute extension of credit to applicant.