ACCOUNT APPLICATION

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Thank you for completing the form below to request an account.  One of our superheroes will process it Ka-Pow quick and contact you so you can enjoy all the great products and services Miller Industrial has to offer.

Account Application
* Denotes Required Field(s)
Company Information
Company Name: *
Website:
Billing Address
Address: *
Suite:
City: *
State: *
Zip: *
Phone: *
Fax: *
Shipping Address
Address: *
Suite:
City: *
State: *
Zip: *
Phone: *
Fax: *
Purchasing Information Request
Purchase Order required?: *
Authorized to purchase: *
First Name * Last Name * Email Role  
 
Add Another
Accounting contact name: *
Accounting contact direct phone number: *
Accounting contact email: *
Fed ID #: *
Tax Exempt Status: *
Tax Exempt Number: *
Terms Choice: *
Statement & Invoice copies: *
Statement & Invoice Email: *
Statement & Invoice Fax: *
Terms
  • I understand terms are Net 30 from date of invoice unless I opted C.O.D. terms.
  • I understand I need to submit three credit references within five business days.
  • I understand I need to submit a copy of the tax resale certificate within five business days.

Email to: accounting@millerindustiral.com

Fax to: 847-616-8084

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