New Customer Form

Thank you for your interest in working with us! At Hacienda La Minita, we pride ourselves on customer service. If you'd rather sign up with us directly, feel free to call us at 1 (802) 318-4133. We can't wait to connect with you.

Company Name

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Same as billing

Shipping address is same as billing address.

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Email

Contact Name

First Name

Last Name

Will La Minita be arranging shipping for you, or will you make your own arrangements?

Who should be copied on delivery orders and Invoices?

Do you require any special shipping instructions? (Delivery days/hours, Lift Gate, Inside Delivery, etc...)

Payment Options: We accept checks, credit cards (Visa, MasterCard, and American Express; a 3.3% fee will be assessed), ACH, and Wire payments. Please note if you pay with check, please mail it to 25186 Network Place, Chicago, IL 60673‐1186.