New Customer Form

Wholesale Account Setup

New Customer Form

Please confirm your basic contact and shipping information so Dillman Farm can set up your wholesale account and route orders correctly.

First Name *

Last Name *

Company Name *

Email *

Phone *

Sales Rep

Tax ID #

Shipping Address *

City *

State *

Zip *

Delivery / Warehouse Phone

Delivery Notes

Special Shipping Services

Lift GateNeeded if you do not have a dock or forklift. Limited AccessGates, rural areas, narrow roads, or hard-to-access docks. ResidentialDelivery to a home instead of a commercial address. Call AheadCarrier should call before delivery. Delivery AppointmentCarrier needs to schedule a delivery time. No Special Services Needed

Important: Shipping Damage Claims

Customer is responsible for inspecting all shipments upon delivery.

Any visible damage must be noted on the carrier's delivery receipt before the driver leaves. If damage is not noted on the delivery receipt, the claim may be denied and no credit may be issued.

Concealed damage must be reported within 3 days of delivery with photos of the damaged product, packaging, pallet, and carrier delivery receipt.

I understand that shipment damage must be noted on the carrier's delivery receipt at delivery, and concealed damage must be reported within 3 days. *

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