Account Set Up Form

Thank you for your interest in our products! Please fill out the form below prior to submitting a purchase order. Our catalog and wholesale terms can be viewed here, and feel free to email amy@woodwardextract.co with any questions.

CONTACT INFORMATION
Ordering contact name *
Ordering contact name
Ordering contact phone number *
Ordering contact phone number
Invoicing contact name *
Invoicing contact name
Invoicing contact phone *
Invoicing contact phone
SHIPPING INFORMATION
Days available to receive shipments *
Please check all that apply.
Do you have a shipping account you would like us to use? *
Please select one.
BILLING INFORMATION
Preferred payment method (please select one) *
Payment for first order due prior to ship date. All major credit cards accepted via Square invoicing. Subsequent orders are eligible for Net 30 terms with payment by check, or payment may be made by credit card prior to ship date.
ACKNOWLEDGEMENT
Name *
Name
Date *
Date