New Customer Sign Up

CUSTOMER APPLICATION FORM

For New Customers
Name of 70E Solutions Employee you are working with:
if applicable
Company Name*
EIN
Employer Identification Number
Company website
ex. 70ESolutions.com
Upload your W-9 Form

Upload a File

Cancelof
Please provide an email we can send tax exemption form to:
example@example.com
Upload your Sales Tax Exemption Form

Upload a File
(if applicable) Cancelof
Billing Information
Billing Contact

This is someone we can contact regarding invoices and payments
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email Address*
Email address for billing contact
Billing Address

This is the address we will send invoices to
Invoice Bill To Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there an email address we can submit invoices to?
example@example.com
Shipping Information
Is your Bill To address the same as your Ship To address?*

YesNo
Attention To*

First NameLast Name
Phone Number*

Area CodePhone Number
Email Address*
Email address for billing contact
Ship To Address line 1*
Ship To Address line 2
City*
State*
Zip Code*
Do you have a Shipping Account Number you'd like us to ship on?*

YesNo
Carrier
Account Number
Is your company Sales Tax exempt?*

YesNo
Please provide the email address of the individual who we can send a request for the tax exemption form from Avalara:*
example@example.com
Please Upload your Tax Exempt Form

Upload a File

Cancelof
Preferred Payment Method*
If you have questions/concerns please contact sales at sales@70esolutions.com or 724-789-7246.
Please provide three Trade References to apply for business credit*
Save time and money by having us manage your dielectric glove rotation!

Send me more information about your Glove Management Program.
TERMS & CONDITIONS

Please read in full before submitting Application:

70E Solutions holds Net 30 credit terms for Business Credit customers.
Terms begin the date the order has shipped.

Freight charges are prepaid and added to customer invoices, unless a customer freight account has been provided to 70E Solutions.

Our Shipping & Return policy can be found at
http://www.70esolutions.com/shipping-returns/

By submitting this application, you accept and are bound to these terms. If you do not wish to be bound by this Agreement, you must notify 70E Solutions, Inc.

By submitting this application, you certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended.

Furthermore, you authorize the reference institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.
I Agree to the Terms & Conditions*

YES
Should be Empty:

CUSTOMER APPLICATION FORM

Billing Information

Billing Contact

Billing Address

Shipping Information

TERMS & CONDITIONS