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Big Rig 12™ New Customer Sign Up...
If you represent a business or organization and you would like to purchase Big Rig 12™ products for distribution and/or as an end user, please provide us with the following information:
*
Indicates required field
Business Name
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Name
*
First
Last
Title
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Department
*
Will you be in charge of all purchases from Big Rig 12™, LLC?
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Yes
No
If no, please provide the name and title of the person who will be in charge of all purchases from Big Rig 12™, LLC:
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Email
*
Primary Address
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Line 1
Line 2
City
State
Zip Code
Country
If your organization has more than 1 location, please specify where your main location/HQ is located:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Shipping Address (if different from above)
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Line 1
Line 2
City
State
Zip Code
Country
Business Phone Number
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Extension
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Business Phone Number 2
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Extension
*
Fax Number
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Cell Number
*
In order to comply with state and local sales tax law regulations, Big Rig 12™ must have in its files a properly executed exemption certificate from our customers who claim a sales tax exemption. If we do not have this certificate, we are obliged to collect sales tax.
After you submit this form, you will be given directions on where to send your tax exempt form, if applicable.
Tax Exempt Status
*
Please charge sales tax, we are not exempt.
Please do not charge sales tax, we are exempt.
Year your business was established? (mm/dd/yyyy)
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Which of the following best describes your organization?
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Wholesaler
Retailer
Manufacturer
Fleet
Lessor
Government Agency/Dept
Other
If Other, Please Describe:
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PLlease give a general description of your organization:
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If possible, please provide a D&B #
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If your organization will be a retail or wholesale distributor, which market segments will you be selling to?
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How many locations does your organization have?
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1
2
3
4
5
6
7
8
9
10
More Than 10
How many locations will you be buying for?
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1
2
3
4
5
6
7
8
9
10
More Than 10
Purpose for Buying Big Rig 12™ products:
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Buying and selling directly to consumers.
Buying and selling to retail dealers/distributors.
Buying for my business/organization internal use.
If you plan on selling Big Rig 12™ products, how many sales people does your organization have?
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1-5
5-10
10-15
15-20
20-25
25+
If you plan on selling Big Rig 12™ products, what are your anticipated annual sales?
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In general terms, how often do you plan on purchasing products from Big Rig 12™?
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As Needed
Weekly
Monthly
Quarterly
Semi-Annually
Annually
Please provide any additional comments:
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