Customer Account Information

Company Name *

Tax ID Number (VAT-EU, RFC-MX, etc.) *

Accounts Payable Email

For electronic invoices.

Shipping Address *

Billing Address *

Contact First Name *

Contact Last Name *

Contact Phone Number *

Contact Email Address

UPS Account Number

Company Website/URL

If you do not have a website, please attach documents in the section titled COMPANY DOCUMENTS.

Company Documents

Maximum file size: 31.46MB

Reasons for Purchase *

Use yourself

For resale

For re-export

For military use

Other (must be explained)Other (must be explained)

Please check all that apply.

If your reason for purchase is Resale or Re-export, you will need to complete these fields.

Country of End User *

Contact Name of End User *

Email Address of End User *

Address of End User *

End Use of Product *

This must be explained.

Happy Holidays from Mitchell Electronics