Staples Charge Account Status

*First Name:

*Last Name:

*Email Address:

Address Line 1:

Address Line 2:

City:

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Zip:

*Phone:

Customer Number:

Order Number:

Did you place an order with us at the time you applied? (2–4 days approval time)

When did you fax your application to us?

CommentsPlease include any other questions you have, or additional details that would be helpful. Note: Please do not include any credit card information on this form.