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New Account Registration

Company

Name: *
Address: *
City: *
State/Province: *
Zip/Postal Code: *

Contact

Name: *
Email: *
Telephone: *

Shipping Address

Address: *
City: *
State/Province: *
Zip/Postal Code: *

Additional Shipping Address

Address:
City:
State/Province:
Zip/Postal Code:

For Resale Tax Purposes

State Registration or
Seller's Permit or
ID Number of Purchaser:
If you have a sales tax license for your company and would like to be tax exempt, please fill out a sales tax exemption certificate and fax it to 913-345-9820. Per state law, we are required to charge the appropriate amount of sales tax until we receive this document.

* Denotes required fields.

I understand that the above information will be verified before an account will be established and that only licensed funeral establishments, licensed funeral directors, embalmers and persons in related funeral industries may establish an account with Pierce.