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PBI Customer Account Request

Company Information

Company Legal Name

Company Email

Street Address

Company Telephone

Country

State/Province

City

Zip/Postal Code

Use as my default billing address

Use as my default shipping address

Main Contact

First Name

Last Name

Contact Email

Contact Phone Number

Reseller Permit File

Do you have a valid resale number? (If based in CA.)

Yes

Resale Number

CA Resale Certificate

(Upload CA Resale Certificate file.) Please download and complete.