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Southland Industrial Supply, Inc.

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Company Name:  

Mailing Address: Street
  City, St
  Zip
Shipping Address: Street
  City, St
  Zip
Phone Number:  
Fax Number:  
Email Address:  
Purchasing Contact: Ext
Acct's Payable Contact: Ext
Federal Tax ID#: County
Sales Tax #: State of Exemption

Credit References: (3 Required)  
Name
Address
Contact
Phone
Fax
Name
Address
Contact
Phone
Fax
Name
Address
Contact
Phone
Fax

Bank Name    
Address    
Contact Account Number
Phone Fax


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Southland Industrial Supply, Inc.
PO Box 1474,  Gainesville, GA 30503
1-800-334-6743 - 770-534-3898 - 770-531-0781 Fax