Open an Account

Complete this form to open an account with DiChickO's.

1. Company

Legal business name *

DBA (if different)

Business type *

Federal Tax ID (FEIN) *

Year established

Website

2. Addresses & Freight

Billing address *

Final delivery city *

Final delivery state *

Freight carrier or forwarder for pickup

Carrier contact name

Carrier contact phone or email

3. Contacts

Name *

Email *

Phone *

Name

Phone

Name

Phone

4. Sales Tax Exemption

Sales tax exemption status *

Certificate number *

Issuing state *

Expiration date

If exempt, email a copy of your certificate to orders@dichickos.com.

5. Signature

Printed name *

Title *

Date *

I confirm the information is accurate and agree to the terms. *

Shipping: FOB Louisburg, NC 27549 standard.
Lead time: Up to 2 weeks for in-stock items, including transit. New production: 4 to 6 weeks.
Payment: Invoices are sent by email and payable online by ACH or CC (CC convenience fees may be applied). Payment terms are set at account approval.

Questions? Heather Harlow, Founder & CEO · heather@dichickos.com · 404.213.8758

DiChickO's LLC | Peri-Peri Supply Co. | 3040 Bluffton Way, Roswell, GA 30075