New Customer Setup

How do I get great food from Regional Access?

Scroll down and fill out the form on this page!

 

If you prefer you can download the PDF below instead and either fax or email it to us.

New Customer Setup Fill In Form


All new accounts need to get set up with ACH payments before the first delivery can be scheduled.

ACH Authorization Fill In Form

 

If your business is sales tax exempt, please download a  W-9 form from the IRS and submit it to us.


If you are having trouble or have any questions call 607.319.5150 x5 or email us.

 

PLEASE NOTE: Regional Access delivers to locations in NY, NJ, MA, PA, and CT. Please check with us before submitting a form if you are not sure we can serve your area. 

 


New Customer Setup Form

 

Please begin the form below by indicating what type of account you are looking to set-up from the drop down menu.