Buckeye Color Lab New Customer Application

This application is for NEW customers only. If you have been a Buckeye customer within the past five years, please call 800.433.1292 for your Buckeye account number.

To establish a new account with Buckeye Color Lab, please complete the application below. Credit Card information is required to establish your account and process your first order. After your account is established, you can discuss other payment options with your account representative.

The security of your information is important to us. This is a secure server. All information on your application will be transmitted through a secure server. If you have any questions, please feel free to call us 800.433.1292.

* Denotes Required Field

*Studio Name:
	(studio name may only contain letters and numbers)
*First Name:
*Last Name:
*Address Line 1:
*Address Line 2:
*City:
*State:
*Zip Code:
*County (Ohio Only):
*Studio Phone:	- -
*Email Address:
*Re-type Email Address:
*Card Type:	American Express Discover MasterCard Visa
*Number:	(no dashes)
*Exp. Date	1 2 3 4 5 6 7 8 9 10 11 12  /  2007 2008 2009 2010 2011 2012 2013 2014 2015
*Name on Card:
*Billing Zip Code:
Do you have a vendor's license?  No:   Yes:

How did you hear about us?
	Website:	Shootsmart.com ProPhotoResource.com MyWBLab.net 7GoodReasons.com Other (Please Specify)
	Speaker Referral:	Bambi Cantrell Will Crockett Jim Garner Jeff & Kathleen Hawkins Ann Monteith Greg Stangle Ellie Vayo Other (Please Specify)
	Magazine:
	Trade Show / Seminar:
	Referral:

Lab Purchases for Last Year:	0 - 1,000 1,000 - 5,000 5,000 - 10,000 10,000 - 30,000 30,000 - 60,000 60,000 +
Type of Work:
Family  Weddings  Sports/Events/Dances  Seniors  Commercial  Underclass/Church Directory  Children  Other:
Promo Code, If Applicable:
Important - Tax Exempt Ohio Businesses - You must download, fill out and fax back to us this Tax Exempt Form so that we may retain a copy for your studio. Please right click the link and choose 'save target as'. Please fill out the form, print it out and fax it back to us. Download Ohio Tax Exempt Form (Word .doc format - fill in)
Please only press the Submit button once. The signup process can take up to one minute to complete.