VIB - New Customer Form
Skip to main content
Please fill out this form to have your business set up as a new customer. New customers are required to make their first payment by credit card. Thereafter, you may contact customer service to change your account to 30 day net.
Today's Date:
6/7/2026 10:48:50 AM
Company Information
Company Name:
Website address:
Address:
City:
State:
Zip:
Country:
Customer Type:
Please Select One
State Customer
Federal Customer
Commercial Customer
Private Customer
Account Type:
Please Select One
Net 30
CC
Credit Limit:
Billing Contact and address
First Name:
Last Name:
Phone Number:
Email:
(Email to be used for invoice and receipts)
Same As Company Address?
Billing Address:
Billing City:
State:
Zip:
Country:
Sales tax exemption Status:
Yes
No
If yes,you will need to submit a copy your sales tax exemption certificate in order to take effect.
Required Documents
VIB Credit Form (Business Customers Only):
Download Here
Sales Tax Exemption:
Submit New Customer Form
©Virginia Industries for the Blind