APPLY FOR AN ATLANTIC SKATES ACCOUNT

NEW ACCOUNTS
Please fill out application. Send it to us. Upon receipt
of your information we will open our web site to you at
which time you can view and/or order. Your e-mail
address will be your user name and the password on your
application will be your private password. Any questions
e-mail [email protected].
You must have a State Resale Tax ID# (or Federal # for those states that do not charge sales tax). And you must have a complete e-mail address.

COMPANY INFORMATION

Company Name

Tax ID/SSN

Contact Person

ACCOUNT LOGIN INFORMATION

Email Address

Password

Re-Enter Password

BILLING INFORMATION

Name

Address Line 1

Address Line 2

City

State

Select a State Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zipcode

Phone Number

SHIPPING INFORMATION

Same as Billing

Name

Address Line 1

Address Line 2

City

State

Select a State Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zipcode

Phone Number

QUESTION / COMMENT

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