New Account Application

Street Address(Required)
Name(Required)
Company Type(Required)
Business Type(Required)
How did you learn about Brimar?(Required)

The undersigned hereby certifies that all tangible merchandise purchased is for the purpose of resale and assumes liability for payment of Retailers Occupational Tax with respect to receipts from the resale of this property to users or customers. This certificate shall be considered part of each order with Brimar.