70E Solutions: New Customer Sign Up

NEW CUSTOMER APPLICATION FORM
Has a 70E Solutions Sales Representative been assisting you? Please enter the name of the representative below:
Company Name:*
Employer Identification Number (EIN):
Company Website:
Upload W-9 Form:

Cancelof
Billing Information:

Please provide the information for the main point of contact regarding invoices and payment details.
Name:*

First NameLast Name
Phone:*
E-mail:*
This e-mail will be sent invoices for payment.
Bill To Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Shipping Information:
Does your bill to address match your ship to address?*

YesNo
Ship To Attn:*

First NameLast Name
Phone:*
E-mail:*
Ship To Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a Shipping Account Number for 70E Solutions to use on your behalf?*

YesNo
Preferred Carrier:
Carrier Account Number:
Is your Company Sales Tax Exempt?*

YesNo
Please provide e-mail address of the individual who we can request the Tax Exemption paperwork:*
Please Upload your Sales Tax Exempt Form (if applicable):

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Preferred Payment Method:*
If you have questions please contact us at sales@70esolutions.com or 724-789-7246.
Provide 3 Trade References to apply for Business Credit:*
Save time & money by having 70E Solutions manage your glove rotation!

Please contact me, I want to learn more about your Glove Rotation Management Program.
TERMS & CONDITIONS

Please read in full before submitting this application. 70E Solutions, Inc. 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.

Review our Shipping & Return policy before application submission. By submitting this application, you accept and are bound to these Agreement 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
Verify to Proceed:*
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NEW CUSTOMER APPLICATION FORM

Billing Information:

Shipping Information:

TERMS & CONDITIONS