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Funeral Business Registration

I would like to establish an account with Wilbert Funeral Services, Inc. to purchase products through WilbertDirect, to use the Wilbert ESP program, and/or to log onto wilbert.com.

Company

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

Contact

Name: *
Email: *
Telephone: *
Wilbert Licensee (if known):

Shipping Address

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

Additional Shipping Address

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

For Resale Tax Purposes

State of Registration:
Seller's Permit Number or
State 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 created for my funeral business.