| Your Company Name and Type | |
| Customer Input or Correction | |
| Ship To Name 1 Customer # Pay From Name | |
| 2 Name | 9 Name |
| 3 Street1 | 10 Street1 |
| 4 Street2 | 11 Street2 |
| 5 Zip | 12 Zip |
| 6 City | 13 City |
| 7 County | 14 County |
| 8 S,P,C | 15 S,P,C |
Misc. Customer Information |
| 16 Index | 26 P.A. | 36 Tax Code |
| 17 Purch Ph | 27 C.M. | 37 Slsp Code |
| 18 Credit Ph | 28 Cont | 38 BO Prio |
| 19 FAX/Telex # | 29 1st Open | 39 Credit Hld |
| 20 Territory | 30 1st Sold | 40 Serv Chrg |
| 21 UPS Zone | 31 Rstk % | 41 Lead From |
| 22 FOB Point | 32 Cust Type | 42 Ship Instr |
| 23 Terms | 33 Prc Code | 43 SVIA Code |
| 24 Limit | 34 Prnt Stmt | 44 Fed Tax Id |
| 25 MFG Code | 35 Sales Loc | 45 Email |
| 1 Customer # -> > |