New Customer Form 2026

Company Name

Company Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail to receive Invoices

example@example.com

Main Phone Number

Format: (000) 000-0000.

Are you interested in these services with MIT Inc.?

Other

Your Name

First NameLast Name

How would you like to setup your account?

In order to proceed with any rental request you will need to agree to MIT, Inc NET30 terms to be eligible for rental equipment.

A rental agreement will also need to be signed before the first rental order of the calendar year is shipped from MIT, Inc.

Additional Company Information

Is your company tax exempt?

Please upload your tax exemption form here

Accounts Payable Contact

First NameLast Name

Accounts Payable E-mail (if different invoices e-mail)

example@example.com

Accounts Payable Phone Number (if different than above

Format: (000) 000-0000.

How did you hear about us?

Where did you find us?

Who referred you?

Other

In order to proceed with any rental request you will need to agree to MIT, Inc NET30 terms to be eligible for rental equipment.

A rental agreement will also need to be signed before the first rental order of the calendar year is shipped from MIT, Inc.

Please verify that you are human

Signature