Customer Setup Account Setup General SetupIf a chain account, you will provide a list to Customer Support with store name, address, hours, and other pertinent information captured in this form (including tax municipalities for VA stores).Your Name (TSM)(Required) First Last Your Email (TSM)(Required) RSM Email(Required) Type(Required)Select OptionNew ChainNew IndependentChain AdditionGroup AdditionChange of ownershipCash & CarryStatus(Required)Select OptionPrimarySecondaryDefunct Chain / Customer Number(Required)Sales Rep assigned to account First Last Food Service Rep(Required)Select OneMelissa DurdenSawyer GoochBrian TimmonsTodd CauffmanDon't knowChain or Group NumberLegal Business Name(Required)Doing Business As(Required)KDM / Primary Contact Name(Required) First Last KDM / Primary Contact Email(Required) Customer Type(Required)Select OptionC-store IndependentC-store President's clubDrug StoreGroceryCollegePrisonFood Service / DeliHotelQSRStore Count(Required)Please enter a number from 1 to 999.Address(s) - Where is our truck delivering the goods?(Required)Street AddressCityZipState Add RemoveStore PhoneSRP LabelsNoYes (Requires Authorization)SRP Price Zone(Required)Select Option(1) L5, M10, H18(2) L12, M17, H22(3) L18, M23, H28(4) L23, M28, H33(5) L28, M33, H38(6) L33. M38, H43(7) L38, M43, H48RP Std Rounding Code(Required)Select Option(E) 9 (default)(A) 1(B) 25(C) 5/9(D) 5/10SubstitutionsYesNoDealYesNoAdd Spark/Fusion to Location?Select OptionYesNoTax & BillingSales Tax Exemption Form(s) Drop files here or Select files Max. file size: 50 MB. State Tax ID #Billing address same as Store Address? Yes, the addresses are the same Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Municipality / County Tax Rate(Required)Select Municipality or CountyNot ApplicableAccomack 10Albemarle 40Amherst 27Arlington 40Augusta 15Bland 40Carroll MONITORINGCaroline 40Clarke 40Craig 40Dinwiddie MONITORINGEssex 40Fairfax 30Fauquier 40Fluvanna 40Grayson MONITORINGGreene 40Halifax MONITORINGJames City 40King George 40Lancaster 40Lee 25Loudoun 40Madison 40Middlesex 40Montgomery MONITORINGOrange 12Page Co 20Patrick 10Prince William 40Prince Edward MONITORINGPrince George MONITORINGPulaski 40Roanoke 25Rockbridge 25Russell 25Smyth 40Spotsylvania 30Stafford 30Sussex MONITORINGTazewell 25Westmoreland 40Wythe 40York 40Gloucester MONITORINGWise MONITORINGCaroline 40Northampton 40City Tax Rate(Required)Select CityNot ApplicableAbingdon 40Alexandria 126Altavista 27Amherst 22Appalachia 25Appomattax 27Ashland 22Bedford City 30Berryville 10Big Stone Gap 25Blacksburg 30Blackstone 22Bluefield 12.5Bridgewater 10Bristol 17Broadway 20Cedar Bluff 10Charlottesville 55Chesapeake 65Chilhowie 40Chincoteague 40Christiansburg 40Claremont 4.5Clincho 5Clifton 30Clifton Forge 4Clintwood 10Coeburn 15Colonial Beach 40Colonial Heights 35Covington 30Crewe* 40Culpeper 15Damascus 15Dublin 40Dumfries 75Eastville 30Edinburg 25Elkton 20Fairfax City 85Falls Church 85Farmville 27Franklin City 70Fredericksburg 31Glade Spring 10Glen Lyn 15Gordonsville 20Goshen MONITORINGGrottoes 20Grundy 5Hampton 85Harrisonburg 30Haymarket 75Haysi 20Herndon 75Hillsboro 35Honaker 25Hurt 17Iron Gate 20Keysville** 20Kilmarnock 30Lebanon 25Leesburg 75Lexington 25Lovettsville 40Luray 20Lynchburg 35Madison 40Manassas 65Manassas Park 75Marion 40Martinsville 30Middleburg 55Middletown 30Mt. Jackson 45Montross 40Narrows 25New Castle 20New Market 25Newport News 85Norfolk 95Norton 25Orange 12Pearisburg 25Pembroke 10Petersburg 90Pocahontas 8Poquoson City 20Portsmouth 95Pound 15Pulaski 40Purcellville 75Radford 40Remington 40Rich Creek 15Richlands 18Richmond 50Roanoke 54Rocky Mount 10Roundhill 40Rural Retreat 40Salem 45Saltville 40Scottsville 40Shenandoah 20Smithfield 50South Boston 10South Hill 15St. Paul 5Stanley 20Staunton 30Stephens City 45Strasburg 25Stuart 10Suffolk 75Tappahannock 15Tazewell 40Timberville 25Toms Brook 25Urbana 40Vienna 85Vinton 25VA Beach 75Wakefield 25Warrenton 40Warsaw 40Waynesboro 30Weber $0.02White Stone 20Williamsburg 40Winchester 50Windsor 40Wise 20Woodstock 25Wytheville 40Accomack 10Albemarle 40Amherst 27Arlington 40Augusta 15Bland 40Carroll MONITORINGCaroline 40Clarke 40Craig 40Dinwiddie MONITORINGEssex 40Fairfax 30Fauquier 40Fluvanna 40Grayson MONITORINGGreene 40Halifax MONITORINGJames City 40King George 40Lancaster 40Lee 25Loudoun 40Madison 40Middlesex 40Montgomery MONITORINGOrange 12Page Co 20Patrick 10Prince William 40Prince Edward MONITORINGPrince George MONITORINGPulaski 40Roanoke 25Rockbridge 25Russell 25Smyth 40Spotsylvania 30Stafford 30Sussex MONITORINGTazewell 25Westmoreland 40Wythe 40York 40Gloucester MONITORINGWise MONITORINGCaroline 40Northampton 40Are these stamps we currently have?Select OptionYesNoCredit Limit Requested(Required)Select Option$5K$10K$15K$20K$25K$30K$35K$40k+Invoice TermsBank Draft - Weekly (default)Will Pay Driver (requires approval)Wire Transfer (requires approval)Zone Price(Required)Select Option(1) 3 1/2%(2) 4 1/2%(3) 4 1/2%(4) 5%(5) 6%(6) 7%(7) 10%(8) 15%Cig Price Zone(Required)Select Option(1) 3 1/2%(2) 4 1/2%(3) 4 1/2%(4) 5%(5) 6%(6) 7%(7) 10%(8) 15%Drop Charge AmountMinimum OrderFreight ChargeRebateDiscount Types Check or A/R Credit EFT Cig. Discount EFT Non-Cig. Discount Cig. Discount - Cents per cartonNon Cig. Discount %Please enter a number from 0 to 100.Route & StopIf chain, Route & Stop information is collected in the store list Excel you upload.This store is open 24 hours True Open Time Hours : Minutes AM PM AM/PM Closing Time Hours : Minutes AM PM AM/PM Store Phone # (not corporate)Nearest MR Williams Customer Account #This store is 18-wheeler accessible True False Will this be a food service account? Yes No Please indicate current delivery windowIs there anything else Transportation should know?Ready for RSM Review I have completed the the setup form and it's ready for my sales leader to review. RSM AcceptanceCAPTCHA