Apricot Customer    or New Customer

Apricot Account Number 

Company/Organization

Department/Cost Center 

Street Address 

Suite/Room # 

City 

State      Zip      Country 

First Name 

Last Name 

Phone Number      Extension

Fax Number 
(Please include area code)

Email Address 
(An email address is highly recommended and required for order confirmations and optional order approval routing)

Website Address 

If you are a Purchasing Manager, do you wish to be contacted to setup a customized authorization process (example)? Y N
(E.g. you can have users make purchase requests and have these requests go to a purchasing manger)

Do you place orders for multiple Company Dept. / Cost Centers? Y N

If Yes, please list the Company Dept. / Cost Centers you order for

Would you like copies of our latest catalog?  If yes, how many do you need?  0 1 2 3 4 5
(You will also be able to request catalogs online using item "CATALOG")

Do you have experience with purchasing over the internet? Y N

How did you learn about our online ordering offering?

How would you rate your experience with Apricot? Excellent Satisfactory Unsatisfactory

Our strong point(s)?

Our weak point(s)?

Do you know the name of your sales rep? Y N

If yes to above, please identify:

Would you like more information on our OfficeFurniture USA product offerings? Y N

Any comments and/or questions are encouraged and welcomed!

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