New Client Onboarding

To streamline our ability to service your needs, please help to populate and submit the following intake form.

Step 1 of 7 - New Customer

I am looking for:(Required)

Receive Sample Units for Evaluation & Testing

Process an Order - Credit Card Payment

Process an Order - Establishing NET/Payment Terms

Customer Contact Information

Main AP/Billing Contact

Main Billing - Name(Required)

First Last

Main Billing - Job Title(Required)

Main Billing - Email(Required)

Main Billing - Phone(Required)

Main Purchasing Contact

Main Purchasing - Name(Required)

First Last

Main Purchasing - Job Title(Required)

Main Purchasing - Email(Required)

Main Purchasing - Phone(Required)

Main Receiving Contact

Main Receiving - Name(Required)

First Last

Main Receiving - Job Title(Required)

Main Receiving - Email(Required)

Main Receiving - Phone(Required)

Billing Information

Main Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Invoice submission email:(Required)

Preferred invoice delivery method(Required)

Shipping Information

Does your company have any shipping accounts that will be used for purchases(Required)

Yes

Carrier Name

Carrier Account Number

Will your company need to ship any parts to Canada?(Required)

Yes

Broker Information

Broker Contact Name

First Last

Broker Company Name

Broker Email

Broker Phone

Broker Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Will your company utilize a Freight Forwarder to deliver parts internationally?(Required)

Yes

Freight Forwarder Information

Freight Forwarder Contact Name

First Last

Freight Forwarder Company Name

Freight Forwarder Email

Freight Forwarder Phone

Freight Forwarder Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is a lift gate required for pallet deliveries?(Required)

Yes

N/A

By clicking "Next" you will be submitting the form.

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2245 Brighton-Henrietta

Townline Road
Rochester, New York 14623

Phone +1 (585) 500-4090
Fax +1 (585) 486-1092

2023

New Client Onboarding

Company Information

Customer Contact Information

Main AP/Billing Contact

Main Purchasing Contact

Main Receiving Contact

Billing Information

Shipping Information

Broker Information

Freight Forwarder Information

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