Customer Setup Request

Become a Valued Customer

NEW – Customer’s Tax Exempt Certificate Now Required for NON-Delaware Customers, excludes those for whom maintenance work is performed at Summit, providing nothing is shipped out of state.

Name
This field is for validation purposes and should be left unchanged.
Customer Name / Business Name*
First Last
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Ship To Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Contact Name*
First Last
Contact Phone No.*
Alt. Contact Phone No.*
Fax No.*
Contact Email Address*
Accounts Payable Contact Name*
Accounts Payable Phone No.*
Accounts Payable Contact Email*
A/C "N" No.*
A/C "SN" No.*
Webpage Address*
Are you a Perks Plus Customer?*
- Yes
- No
Does Customer require other than the standard? If so, indicate markup for: parts, freight or services (separately), in order for the correct pricing to be generated.*
- Parts
- Freight
- Services
Summit's payments terms have been discussed with the Customer, and they agree as follows:*
- To pay in full prior to A/C and/or services delivery via cash, check, or credit card
- To complete the application process for a terms account with Summit (can take upward of three weeks to complete)
The information in this form is being submitted by:*
First Last
Please select today's date:*

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Become a Valued Customer