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	Become a Customer

	If you are a retail business owner and wish to open an account with RaxUSA, please fill in the form below. A customer service representative will contact you within 24 hours.
		* - Required Fields
*	First Name:
*	Last Name:
*	Email:
*	Phone:
	Fax:
*	Company:
	Title:
*	Type of Business:
		What RaxUSA products are you interested in?
*
		How long have you been in business?
*
		What trade shows, if any, do you attend?

		You must enter at least one of the three fields below.
*	State Resale Certificate:
*	Business License:
*	Federal Tax ID:
		Billing Address
*	Address1:
	Address2:
*	City:
*	Postal Code:
*	Country:
		Shipping Address (if not the same as billing)
	Address1:
	Address2:
	City:
	Postal Code:
	Country:
		I have a website.
		I have an internet connection at my place of business.
		How did you hear about us?
		ASR Show Transworld Skateboarding Business Manufacturer Received e-mail from us Received mail from us Search Engine Friend or Colleague - Please Specify Other - Please specify
	Comments:

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