Welcome to Rogers!

New Customer - Registration Form

Rogers Supply Co./Rogers Craft Source is a wholesale supplier of scrapbooking, rubberstamping, paper crafting, and office supplies. If you are not currently an active customer of Rogers, but would like to set up an account, please fill out the form below. Since we only sell to the Retail Trade and are unable to set up an account for direct sales to a consumer, we require that you supply us with a valid state Tax ID Number and a copy of this form. Once we receive your fax of the Tax ID Certificate we will follow-up on the information you provide on this form. We are sure you can understand our effort to assure that we are not selling direct to consumers, and thus are not in conflict with our retail customers. After the approval process is complete, we will email your username and password.

REQUIRED FIELDS DENOTED WITH AN: *

Billing Information:

Choose one of the following payment options: *
COD MONEY ORDER ONLY
CREDIT CARD We take Visa, MC, AMEX, Discover.

New customers must have a valid credit card on file with us. Please enter your information here, or if you prefer, fax the information to 303-756-0221. Be sure to include your business name and phone number on the fax so we can match it correctly.
	CARD HOLDERS NAME:
	ACCOUNT NUMBER:
	CARD COMPANY:
	EXPIRES:
	SECURITY NUMBER :
In order to qualify for credit with us, we require that you have established good credit with other companies for at least one year. If you meet this qualification and wish to apply for credit terms, you may complete the credit application form on this website once you receive your username and password.

COMPANY NAME:

TYPE OF BUSINESS:

FIRST NAME:

LAST NAME:

TITLE:

ADDRESS 1:

ADDRESS 2:

CITY:

STATE:

ZIP:

COUNTRY:

RESIDENCE?:

ENTER THE SHIPPING ADDRESS INFORMATION
IF IT IS DIFFERENT FROM YOUR BILLING ADDRESS

SHIPPING ADDRESS 1:

SHIPPING ADDRESS 2:

SHIPPING CITY:

SHIPPING STATE:

SHIPPING ZIP:

SHIPPING COUNTRY:

SHIPPING ADDRESS
IS A RESIDENCE?:

TAX ID NUMBER:

In order to process your request we need a copy of your tax id on file. Please fax this to us as soon as possible at 303-756-0221 referencing your business name and phone number so we can match it correctly.

STATE ISSUED:

PHONE:

FAX:

EMAIL ADDRESS:

WEB SITE:

ADDITIONAL COMMENTS
OR INFORMATION:

Fax: 303-756-0221
Phone: 303-757-4907