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New Customer Form - On Account

Please complete the form below and click submit.

Our payment terms are Net 30 days. Please allow ample time for the credit approval process.

If you are working with one of our sales or design engineers, please provide the name here:

Expected $ amount of initial order

Company Name

Contact First

Contact Last

Job Title

Email Address

Industry

Phone Number

Billing Address

Billing Address 2

Billing City

Billing State

Billing Zipcode

Shipping Address 1

Shipping Address 2

Shipping City

Shipping State

Shipping Zipcode

Shipping Terms

Shipping Location Delivery Info

Delivery Location has a SECURITY GATE

Delivery Location has a FORKLIFT

Delivery Location requires APPOINTMENT

Default Delivery Contact Name

Default Delivery Contact Phone Number

Collect Account #

Carrier Choice

Other Carrier

A/P Contact First

A/P Contact Last

A/P Contact Phone

A/P Email Address

Tax Exempt? (If yes, email certificate to accountingteam@neffpower.com)

Bank Name & Address

Bank Phone

Federal ID #

DUNS #

NAICS/SIC Code

Credit References (copy & paste) or email to accountingteam@neffpower.com

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I would like to have access to online ordering with Neff Power.

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New Customer Form - On Account

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