Gold Rush Express Delivery New Account Application
Please print and mail or fax this application to:
Gold
Rush Express
910
Bern Court
Suite 135
San Jose, CA 95112
FAX: [408]
292-8002
Company Name:_____________________________________________________________
Applicant's Name:_______________________ Main Contact:____________________
Address:________________________ City:____________ State:____ Zip:________
Mailing Address (leave blank if same as above):___________________________
City:________________ State:___________ Zip:_______________
Phone Number:________________________ Fax Number:_________________________
E-mail Address:___________________________ Website:_______________________
Agree to Net 15 terms?:___________________________________
Nature of Business:_______________________________________________________
__________________________________ _____________________________________
Printed Name Title
____________________________________
Signature
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