Up to 60% off Select Static Mixers! Shop Now

Become a Customer

Apply to become an established customer. Once you become a customer you will be able to pay by Purchase Order when you checkout.

Once you submit the form please allow us time to process and approve your request.

Customer Information

"*" indicates required fields

Company Name*

Phone*

Fax*

Ship to Address

Ship To Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bill to Address

Bill To Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Accounts Payable Contact

First Name*

Last Name**

Voice*

Fax*

Email*

Purchasing Contact

First Name*

Last Name**

Voice*

Fax*

Email*

Business Information

Business Type*

Dun and Bradstreet Number*

Tax Identification Number*

Year Established*

My business is…*

Taxable

Non-taxable

Taxable*

Please provide your tax rate.*

Non-taxable*

Please upload a copy of your tax exemption certificate.*

Accepted file types: jpg, png, pdf, Max. file size: 10 MB.

Phone

This field is for validation purposes and should be left unchanged.