BusinessIQ

General Information

Sales Rep Name

How did you hear about Air Hydro Power?

Credit Limit Request

If Credit Limit is Other, Please Specify

Company Information

^*Business Name

Doing Business As (DBA Name)

^*Tax ID

^*Billing Address

^*City

^*State/ Province

^*Zip/Postal

Country

^*Shipping Address

^*City

^*State/ Province

^*Zip/Postal

Country

^*Accounts Payable Contact Name

^*Telephone

^*Email Address

Telephone - Work

Email Address

Legal Structure

Type of Business

NAICS Code

^*Are you Tax Exempt?
Yes No

Number of Employees

Year Business Established

What County is the business located?

All invoices are emailed unless otherwise coordinated with Air Hydro Power Accounting department.

Email (Where invoices should be sent):

Officer/Owner Name

Officer/Owner Title

Officer/Owner Phone and Email

Preferred shipment method (under 150 lbs)

Is it PPA or Collect?

If Collect please provide Collect Number

Note: If a collect number is provided, Air Hydro Power charges a $5.00 handling fee.

Preferred LTL carrier (over 150 lbs)

Preferred method

Trade Reference Information

Reference Name

Contact Name

Contact Email

Reference Name

Contact Name

Contact Email

Reference Name

Contact Name

Contact Email

Bank Reference Information

Bank Name

Bank Contact Name

Bank Contact Phone Number

Bank Contact Email Address

Attachments

Please attach documents relevant to the application decision process (i.e., company financials, relevant license information, etc)

Attachment Description

Attachment Location

Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.

Terms and Conditions

^*Signature of Applicant

^*Title

^*Date

PRINT AGREEMENT

I agree to the terms and conditions specified above.

User Verification

Please complete the following by entering the value EXACTLY how it appears(case sensitive)

Why do I have to do this?