Business Info Customer Type * - Select -DesignerRetail StoreInternet StoreHospitalityOther (Please specify) Customer Type Other (Please specify) Business Name * Website Tax I.D. or E.I.N. * New or Existing Customer? New Existing Customer Number Billing Information* Billing Country * United StatesCanada Address * City * State* - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Province* -Select-AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip/Postal Code * Shipping Address Same as Billing Shipping Address Shipping Country * United StatesCanada Address * City * State* - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Province -Select-AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip/Postal Code * Shipping Information Ship Via 3rd Party Billing Info LTL Carrier Drop Ship Fee Returns Allowance Freight Chargeback Fee Discounts Ship Window Shipping Prepaid Yes No Order Notifications Yes No Main Contact Info* Main Contact Name * Main Contact Phone * Main Contact Fax Main Contact eMail * Accounting Contact & Credit Info* Accounting Contact Name * Accounting Contact Phone * Accounting Contact Fax Accounting Contact Email * Upload Tax Certificate (image or PDF) Files must be less than 2 MB.Allowed file types: gif jpg jpeg png bmp txt rtf pdf doc docx odt ppt pptx odp xls xlsx. Website Login Account Info First name * Last Name * Username * Password * I agree to Colonial Mill's Credit Terms I agree to Colonial Mill's Policies and Procedures I agree to Colonial Mill's MAP Policy