Intralox New Customer Set-up Form

Intralox Conveyor Belts (Shanghai) Ltd.

No. 23 Workshop E-mail: cs.asia@intralox.com
No. 150 Rijing Road TEL : +86-21-5111-8400
Waigaoqiao, Shanghai, P.R.C.
200131 For Toll-Free number, please visit www.intralox.com

SOLD TO ADDRESS

Company Name:
Address:
City: Main Phone #:
State: Main Fax #:
Post Code: Web Site:
Contact First Name: Direct Phone #:
Contact Last Name: Mobile Phone #:
Position / Job Title: E-Mail Address:
Business Type: Please select
Industry Focus: Please select

CONSIGNEE NAME (For Customs clearance & shipping documentation purpose)

Company Name:
Address:
City: Main Phone #:
State: Main Fax #:
Post Code: Web Site:
Contact First Name: Direct Phone #:
Contact Last Name: Mobile Phone #:
Position / Job Title: E-Mail Address:

DELIVERY ADDRESS (If different from Consignee name/address)

Company Name:
Address:
City: Main Phone #:
State: Main Fax #:
Post Code: Web Site:
Contact First Name: Direct Phone #:
Contact Last Name: Mobile Phone #:
Position / Job Title: E-Mail Address:

INVOICE

Would you like to receive e-invoice?: Please select

Email address(es)
**Please note thatfor receiving
if you the
opt for E-invoices:
receiving E-invoices, you will no longer receive a printed invoice.

INVOICE MAILING ADDRESS (If different from sold to address)

Company Name:
Address:
City: Main Phone #:
State: Main Fax #:
Post Code: Web Site:
Contact First Name: Direct Phone #:
Contact Last Name: Mobile Phone #:
Position / Job Title: E-Mail Address:

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