MyBinStock Request Form
Please complete the form below. We will contact you within the next 2-3 business days.
Fields marked with an Asterisk (*) are required information.
* Required
Company Name:
*
Your answer
Decision Maker's Name:
*
Your answer
Title:
*
Your answer
Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
ZIP:
*
Your answer
Email Address:
*
Your answer
Best Contact Phone:
*
Your answer
KL Jack Customer:
*
YES
NO
KL Jack Customer ID #:
(Account #) - Found on a K.L. Jack Pick Ticket (Above PO Number Box).
Your answer
KL Jack Sales Rep:
Enter Your Current KLJ Outside Sales Rep
Your answer
Company Industry?:
*
Manufacturing, General Construction, etc.
Your answer
How often do you place orders with KL Jack?:
*
Choose
CHOOSE ONE:
Daily
Every few days
Once a week
Every few weeks
Once a month
Whenever I need something
I currently do not buy from KL Jack
How do you place orders with KL Jack?:
*
Choose all that apply
Local Branch
Phone
Email
Fax
Online
KL Jack Outside Sales Rep
I currently do not buy from KL Jack
Required
How Did You Hear About MyBinStock?:
KLJACK.com
Local KL Jack Branch
My Outside Sales Rep
Email
Direct Mail
Coworker / Friend
Web Search
What types of products do you often purchase?:
*
Choose all that apply
Abrasives
Auto & Electrical (terminals, hand tools, cable ties, wire, etc..)
Chemicals & Janitorial
Industrial Contractor Supplies (caulking, floor protection, diamond blades, etc..)
Cutting Tools & Accessories
Fasteners
Hand Tools
Masonry Anchors
Safety Products
Spray Foam Insulation
Strut & Hangers
Tape (electrical, duct, barrier, anti-skid, etc..)
Other:
Required
Additional Information We Should Know About Your Company:
Your answer
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