Customer Information

Customer Information

Thank you for choosing Nexthermal! Please fill out the information below to help us streamline the shipping and payment process for you. If you have any questions, you may call us at (269) 964-0271 or email us at m.watters@nexthermal.com.
Name*

First NameLast Name
Email*
example@example.com
Company*
Nexthermal Rep.*

Shipping Information
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is the Billing Address the same as the Shipping Address?*

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Method*

No PreferenceFedExFedEx CollectUPSUPS CollectOther
Collect Account
Insured Shipment*

YesNo

Payment Information
Accounts Payable Email*
**Invoices will be emailed to this email address**
Tax Exempt?*

YesNo
Please Upload Your Tax Exemption Form*

Cancelof
Tax ID # or FEIN
Payment Method*

Prepay via Credit CardPrepay via Wire/ACHRequest for Terms
Payment Method (Int.)*

Prepay via Credit CardPrepay via Wire/ACH
Should be Empty: