Dickies® B2B ~ New Customer

Feb 7, 2012

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NEW CUSTOMER REQUEST

For companies that are interested in becoming Dickies customers.

Please complete all fields to send your customer inquiry to Dickies. Once your request has been reviewed, a Dickies salesperson will contact you to discuss your needs. If you have any questions, please contact our Credit Dept. at 1-800-336-7201 ext. 5336.

Please note: this form is for U.S. companies only. For International inquiries, please contact our International Department at 1-800-336-7201 or (817) 336-7201 or acirilo@dickies.com.

Company Name:

Address:
(use both lines if necessary)

City:

State:

(If you are not a U.S. based company, click here to contact our international department.)

Zip Code:

Tel #:
(e.g. 123-123-1234)

Fax #:
(e.g. 123-123-1234

Dun & BradStreet#
(if available):

Email Address:

Website Address:

http://

Contact Name:
(Purchasing Officer)

ASI Number:
(if available)

Type of Store:

	Adverstising		Army / Navy
	Rental Laundry		Contract Bidder
	Discount / Mass Merchandise		Fashion Apparel
	Hardware / Home Center		Paint
	Sporting Goods		Screen Printer / Embroidery
	Traditional Dept. Store		Uniform Dealer
	Specialty/Retailer		Employee Uniforms/End User

Click on submit to send your request to dickies.
You will then be redirected to our on-line catalog.

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