New Customer Form - MSAIR Texas

Step 1 of 3 - Page 1

Billing Information

Company Name(Required)

Industry(Required)

If Other, List Industry Here(Required)

Address(Required)

Street Address Suite/Floor City State ZIP

Main Phone(Required)

Main Fax(Required)

Employeer Identification Number(Required)

Tax Exempt(Required)

Yes

Reason Tax Exempt(Required)

Resale

Manufacturing

Upload Your Sales Tax Use Form(Required)

Accepted file types: jpg, png, pdf, Max. file size: 2 GB.

Resale Only: Sales Tax & Use Permit Number(Required)

Primary Payment Method(Required)

Check

Credit Card

ACH (Direct Deposit)

Main Point of Contact

Name(Required)

First Last

Phone(Required)

Fax(Required)

Email(Required)

Estimates Contact

Name(Required)

First Last

Phone(Required)

Fax(Required)

Email(Required)

Accounts Payable Contact

Name(Required)

First Last

Phone(Required)

Fax(Required)

Email(Required)

Invoicing Email Address(Required)

Are Purchase Order (PO) #'s Used?(Required)

Yes

Are Purchase Order (PO) #'s REQUIRED?(Required)

Yes

Persons Authorized to use PO's with MS AIr(Required)

Name of Person Completing This Form(Required)

First Last

Date(Required)

Is the service site location different from billing information?(Required)

Yes

Facility Location Information

Facility Name(Required)

Address(Required)

Street Address Suite/Floor City State ZIP

Main Phone(Required)

Site Contact Person(Required)

First Last

Billing Information

Main Point of Contact

Estimates Contact

Accounts Payable Contact

Facility Location Information

Site Operating Hours

PPE Required

Location

Business hours

24/7 Emergency #

24/7 emergency #

24/7 emergency #