Regional Customer Credit Application & Account Setup

Regional Customer Credit Application & Account Setup – Americas

Welcome to Peli BioThermal! We’re excited to support your temperature-controlled packaging needs. Please complete this form so we can set up your customer account and review your credit application. All information provided will remain confidential and will only be used to establish and support your account with us.
NanoCool Product OnlyPeli BioThermal Product OnlyBoth NanoCool and Peli BioThermal Productevo Product Only
Disclaimer: Please note that if you select both NanoCool and Peli BioThermal products on this application, two separate customer accounts will be created. Each product line is maintained within its own system and requires its own unique account setup.
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
D&B No.*
FEIN #*
Telephone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of address for invoicing purposes if different from above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
AP Contact Name*

First NameLast Name
AP Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
AP Contact Email Address*
example@example.com
Purchasing Contact Name*

First NameLast Name
Purchasing Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Purchasing Contact Email Address*
example@example.com
Expected Monthly Purchases ($)*
WireCheck
YesNo
Tax Exempt Certificate

Cancelof
For Non-Limited Companies, please include Proprietor(s)/Partners Names
TRADE REFERENCE
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Telephone No.*
Please enter a valid phone number.Format: (000) 000-0000.
Company Email*
example@example.com
BANK DETAILS
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Account No.*
Routing No.*
Bank Contact*

Ship To Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Delivery contact name*
Delivery phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Method*
Shipping Type*
Shipment Payment Type*
Your Shipping Account No*
Shipping Details for shipping address 1
Is there a loading dock to receive freight shipments?
Is a truck with a lift gate needed (additional fee)?
Do you have a fork lift or pallet jack?
Do you need inside delivery (the driver will carry the shipment through the threshold of the delivery location; additional fee)?
Is the shipping address classified as being in a residential area (additional fee)?
Will you require the shipping company to contact you with a delivery notification (freight only; additional charge)?
Warehouse/shipping department receiving hours:
Are there any other potential difficulties the delivery truck may have with getting the truck in and/or accomplishing the delivery?
Other Special Instructions
If using more than one shipping address, complete the sections below with shipping information including special instructions.
Ship To Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Delivery contact name
Delivery phone number
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Method
Shipping Type
Shipment Payment Type
Your Shipping Account No
Shipping Details for shipping address 2
Is there a loading dock to receive freight shipments?
Is a truck with a lift gate needed (additional fee)?
Do you have a fork lift or pallet jack?
Do you need inside delivery (the driver will carry the shipment through the threshold of the delivery location; additional fee)?
Is the shipping address classified as being in a residential area (additional fee)?
Will you require the shipping company to contact you with a delivery notification (freight only; additional charge)?
Warehouse/shipping department receiving hours:
Are there any other potential difficulties the delivery truck may have with getting the truck in and/or accomplishing the delivery?
Other Special Instructions
DECLARATION

To be signed by a Company Director or an authorized company signer.

I/We agree to operate our account in accordance with the standard terms of sale.

I/We give consent to our bankers to disclose information on the above bank account for the purpose of establishing credit limits.

I/We agree that Peli BioThermal LLC may make inquiries, as they consider necessary, in connection with this, or any other future application with them or any other member of the Pelican Group.

CREDIT: All Terms are subject to credit approval. Unless otherwise agreed by Seller, payment is due in US dollars. If Buyer fails to make payments in accord with Seller’s terms, then Seller may at Seller’s option, cancel the unshipped balance of any order and seek other remedies in equity or law. If Buyer’s account is delinquent, no outstanding orders will be shipped until overdue balances have been paid. A service charge of 1.5% per month will be added to all past due amounts. Buyer shall reimburse Seller for any costs incurred in collection of amounts owed, including reasonable attorneys’ fees and costs.

TERMS: Terms are net 30 days from invoice unless non satisfactory references in which case payment is due before shipment. Buyer shall pay from invoice;
Signature*

Clear
Title*
Date*

MonthDayYear
Date
Should be Empty:

Regional Customer Credit Application & Account Setup – Americas

TRADE REFERENCE

BANK DETAILS

Shipping Details for shipping address 1

If using more than one shipping address, complete the sections below with shipping information including special instructions.

Shipping Details for shipping address 2