EZ Online Account Set up

Please fill out the following so that we may be able to activate your account. The required information will allow us to customize your on-line menu's so you see only the products and brands you like and need, so please be as specific as possible.

Company Information ( * denotes required input.)

* Company Name:

* Contact Name: * EMAIL:

New Customer? Current Customer?

If Current Customer, Your Account Number:

Were you referred by anyone? If so, by whom:

* Phone Number: FAX Number:

Company Website:

* Your Company BILL TO Address:

Street:
City:
State:     Zip Code:

* Main SHIP TO Address:

Street:
City:
State:     Zip Code:

TAX INFORMATION

* County where business located (for tax purposes):

Tax Exempt? Yes No Tax ID Number:

PAYMENT INFORMATION

Please choose preferred method of payment (for new accounts only, current accounts please skip):

Invoiced Net 30 Day Account Credit Card COD

(If you selected the Credit Card option above you will be contacted when account is being setup.)

Product Menu Selection:

Current Battery Vendor:

Please check below the types of batteries you currently buy and would like to see in your online menus. Also give as much information possible on what brands / models you currently use and how many you use annually. This information is not mandatory but it will help us design your menus to your exact needs and help you get the best price possible.

Cellular Batteries