Wholesale Account Application Form

New Customer Information Form

This is NOT a credit application: Please complete the form below in order to receive preferred customer benefits from Performance Maintenance, Inc. All orders must be paid prior to or upon deliver. This form is to be completed and submitted along with the PMI Credit Application to be considered for an on-going Business Account.
Customer Name*
Business Name*
Point of Contact
Phone:*

Area CodePhone Number
Ext.
Fax:

Area CodePhone Number
Billing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
Website:*
Is your shipping / delivery address different from the above address?

YesNo
Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please see our Northern New Mexico FREE Delivery Schedule.

PMI can deliver to one or multiple locations upon request.

UPS cannot ship to a P.O.Box
Is your company tax exempt?

YesNo
If yes, please submit Nontaxable Transaction Certificate (NTTC) from NM Taxation and Revenue Dept.

PMI CRS#03-540635-00-6
Business Representative Information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Message

0/500
NTTC / Tax Exempt Form Upload

Browse Files

Cancelof
Note:

Must be renewed annually.
Signature*

Clear
Should be Empty:

New Customer Information Form

Business Representative Information