New Business Form | Fire & Safety

New Business Application (1)

This form is designed for new customers to use to enter their business information.

Business Name(Required)

DBA or Also Known As:

Business Phone(Required)

Business Type(Required)

What services or products are you interested in?(Required)

Equipment sales such as Turnout gear, SCBA, uniforms, tools, etc.

Hood cleaning

Sprinkler Systems

Fire Extinguishers, Kitchen or paint booth systems, etc.

CPR or OSHA training

Physical Address(Required)

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

Mailing Address (if different)

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

Main Contact Name(Required)

First Last

Main Contact Email

Billing Contact Name (if different)

First Last

Billing Contact Email(Required)

Type of Organization(Required)

Business Tax ID(Required)

Owner's Name (if applicable)(Required)

Owner's Cell Phone Number(Required)

*Owner's home and contact information required for all restaurants

Owner's Home Address(Required)

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

Bank Information

Company's Bank

Bank Representative

Bank Phone Number

Bank Address

Bank Account Number

ARE YOU REQUESTING PAYMENT TERMS? ANSWER BELOW

Are you requesting payment terms?(Required)

(If you answered no, then payment is required prior to, or at the time of service)

Credit Application MUST BE COMPLETED IN FULL

Credit Terms Requested(Required)

Credit Reference #1 Name(Required)

Credit Reference #1 Account Number

Credit Reference #1 Phone Number(Required)

Credit Reference #1 Email(Required)

Contact Name(Required)

First Last

Credit Reference #1 Address(Required)

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

Credit Reference #2 Name(Required)

Credit Reference #2 Account Number

Credit Reference #2 Phone Number(Required)

Credit Reference #2 Email(Required)

Contact Name(Required)

First Last

Credit Reference #2 Address(Required)

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

Credit Reference #3 Name(Required)

Credit Reference #3 Account Number

Credit Reference #3 Phone Number(Required)

Credit Reference #3 Email(Required)

Contact Name(Required)

First Last

Credit Reference #3 Address(Required)

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

Sales Tax Information

Are you Tax Exempt?(Required)

Tax Exempt Number(Required)

Tax Exempt Form(Required)

Max. file size: 128 MB.

How did you hear about us?

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Second Choice

Third Choice