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Pumps, Instrumentation & Controls for Water Treatment






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Credit Application

To set up a customer account with net 30 terms (subject to credit review and approval), please fill out the application form below. Filling out an application is easy and usually takes less than 10 minutes.

If you have any questions, please contact our corporate offices at 888-265-5632, or email us at APInvoices@accent-control.com

If granted credit, I agree to pay all invoices according to your terms of Net 30 days, Accent Control Systems reserves the right to cancel applicant’s credit at any time without notice. In the event Accent Control Systems commences litigation or employs attorneys in order to secure payment of any sums due it from applicant, the applicant agrees to pay attorney and/or collection expenses, plus interest at 1.5% per month (18% annually) in addition to balances owed. The undersigned acknowledges that the above agreement has been carefully read and that the applicant understands and agrees to the same.


* All fields marked with an asterisk are required to be filled out before the form can be submitted.

Business Information

Company Full Name
Company Phone Number
   Company Fax Number
Company Billing Address 1
   Company Billing Address 2
Company City
Company State / Province
Company Zip / Postal Code
Company Country
Company Email Address
Company Contact
Years in Business
Product Sold/Mfg.
   D&B Number
Federal Tax ID
Type Of Business
How should we invoice you?
Mail to billing address
Email invoice to:
Fax invoice to:
 

Business Owners or Officers

  Name Title  
1)  
2)  

Trade References (Businesses currently selling to your firm)

  Reference #1 Reference #2 Reference #3 Reference #4
Name  *   *   *   * 
Address                    
City                    
State                    
Zip                    
Phone                    
Fax  *   *   *   * 
Email  *   *   *   * 
Do You Qualify For State Sales Tax Exemption?   

If yes, please send us a copy of your sales tax exemption certificate:
Email: APInvoices@accent-control.com

Or upload a copy here: (PDF Required)


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