Kathy & Jim Simpson Present

Simpson Sales

1.800.900.7140	Telephone
1.800-900-3152	Facsimile

103 S. US HWY # F-5 PMB 153

Jupiter, Fl 33477

New Account Information

[Please note that we do not sell directly to the public, you MUST have a valid Tax ID number]

Please provide the following information:

Name

Title

Company

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Phone

Cellular Phone

FAX

E-mail

Web Site Address

Tax ID Number & Business License ID MUST Be Faxed or E Mailed to our attention:

	Fax to: 1.800-900-3152
	E Mail to: jim137@comcast.net
	E Mail to: kathy137@comcast

ID Number

Years On Business:

Type of Business:

[If you selected other, please indicate your business type in the space provided below:]

Please let us know you found us. Maybe after years in business, a referral from someone

or where ever. Please just write us a few words.

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Name
Title
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Phone
Cellular Phone
FAX
E-mail
Web Site Address