CONTACT MAINE OXY

Account Type*

BusinessIndividualExisting Account
Payment Method*

ChargeCredit CardCash on Delivery (COD)
Invoice*

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*Please know that there is a $1.00 processing fee for mailing paper invoices.
PLEASE COMPLETE OUR ONLINE REGISTRATION FORM

You will need your account number and contact information for the user.
Full Name*
Email*
Phone Number*
Format: (000) 000-0000.
Business Name*
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Zip Code
Different Shipping Address?*

YesNo
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Shipping Zip Code
Business Information
Business Tax ID Number*
*Business Tax ID only. Do not enter your Social Security Number.
Estimated Annual Sales*
PO Required?*

YesNo
Tax Status*

TaxableTax Exempt*
Type of Tax Certificate*
Please upload your tax certificate*

*Resale certificate is required for tax exempt accounts.
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Do you intend to purchase medical gases*

YesNo
Please upload your medical certification document*

*Choose a medical gas license document to upload.
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Terms & Conditions

TERMS: 30 DAYS FROM THE DATE OF INVOICE. SERVICE CHARGES OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS I agree to pay according to the above terms and to be liable for all service charges (currently at the rate of 1.5% PER MONTH, 18% PER ANNUM) on any amount still outstanding beyond the end of the month following the purchase. Customer agrees that TITLE TO CYLINDERS WILL REMAIN SOLELY WITH MAINE OXY ACETYLENE SUPPLY COMPANY. Also, it is agreed that any collection or legal fees which are incurred by MAINE OXY in the collection of this account will be the responsibility of the undersigned. This agreement constitutes a security interest in the equipment which are the subject of thereof. Lessee grants a security in, and a general lien upon the equipment and proceeds thereof. The lessee agrees to cooperate with the Lessor and expressly permits Lessor to execute and file financing statements and take such other actions as shall be required to perfect the Lessor’s security interest in the Equipment in accordance with this Agreement.
Required*

I agree to above statement and guarantee that the above information is true and provide authorization to obtain information necessary to complete this account application.By submitting this application, you authorize Maine Oxy to conduct a full credit check as part of our account approval process for welding supplies and industrial gas services. This inquiry may appear on your credit report and can affect your credit score.
Additional Notes:
How did you hear about Maine Oxy?*

Word of MouthSales CallInternetMarketing PromotionOther
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By providing your email address, you agree to receive periodic marketing emails, newsletters, promotions, and updates from us. You may unsubscribe at any time by clicking the “Unsubscribe” link included in every email. We value your privacy and will never sell or share your information with third parties.
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