What type of business do you have?*

How many years have you been in business?*

1 Year

2-5 Years

6-10 Years

What type of products do you need?*

Custom Packaging

Equipment

Facility Supplies

Food Service

Janitorial Supplies

Packaging

Warehouse & Shipping Supplies

Who is your current supply source?*

Distributor

Manufacturer

Retail

Wholesale

How often is delivery needed?*

How many shipping locations do you have?*

1-2

3-4

6+

What is your annual spend for packaging and supplies?*

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Unfortunately, it looks like we do not support your needs.

Thank you for your interest in Cogent. We are a commercial supplier with a specific market delivery area and unfortunately, it looks like we do not support your market area or your supply level needs. If you think you’ve reached this message in error, please contact us at (800) 237-3103.

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New Customer Input Form

Company Legal Name/DBA:*

Company Website

Billing Address:*

City:*

State:*

ZIP Code:*

Purchasing Contact:*

Phone:*

Email:*

A/P Contact:*

Phone:*

Email:*

Email Address for Invoicing:*

Preferred Payment Type Requested

Terms Requested

Credit Card

Referred By:*

Referred By Name:

Delivery Information

Ship To (Name):*

Delivery Address Same as Billing Address:

Delivery Address Same as Billing Address

Delivery Address:*

City:*

State:*

ZIP Code:*

Shipping Contact:*

Phone:*

Receiving Hours:

From:

:

To:

:

Liftgate Required?

Yes

No

Delivery Instructions:

Resale Certificate Form:

Please download the Resale Certificate form and upload it in the next field: Resale Certificate Form

Resale Certificate Upload:

Accepted file types: pdf, doc, docx, txt, rtf, jpg, png, gif, Max. file size: 10 MB.

Additional Shipping Address?*

Yes

No

Number of Additional Addresses:

Additional States:

Additional Shipping Addresses Form:

Please download the form, fill it out, and upload it in the next field: Additional Shipping Addresses Form

Additional Shipping Addresses Upload:

Accepted file types: pdf, doc, docx, txt, rtf, xls, xlsx, csv, Max. file size: 1 MB.

Cogent Account Request

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Unfortunately, it looks like we do not support your needs.

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Welcome to Cogent

New Customer Input Form

Delivery Information