Untitled Document

 

New Customer Form

 

Welcome!

Fluid Power Engineering has provided the following online application for credit form for your convenience. IMPORTANT: Please fill in all (required) fields below.

Company name
Your name
(first, last.)
Your e-mail address
(e.g.: you@aol.com. Must be a valid address.)
Street address
City
State, ZIP
Phone
Fax
  *Note: We fax all invoices. The fax number you supply above should be that of your Accounts Payables department.
   
Years in business
   
If your company is sales tax exempt for purchases from our company, enter your tax exempt number:
 
   
List three references of companies with which you are currently doing business.
No leasing companies, please -- use resale houses if possible. We do not accept banks or steel companies as references.
   
Reference 1  
Company name
Account #
Phone
Fax
   
Reference 2  
Company name
Account #
Phone
Fax
   
Reference 3  
Company name
Account #
Phone
Fax
   

 

Fluid Power Engineering • 847-364-7455