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.

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:*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Become a Valued Customer