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Safe-T-First makes it easy to order our products on-line in a secure environment. This ensures your personal and credit card information is safe.

New customers:

Company name:

Telephone:

Address:

City:

State:

Zip Code:

Corporation

Partnership

Sole Proprietorship

Trade Style(s):

Principal(s):

Request of this information does not constitute acceptance of any order -- it will allow us to expedite the credit procedure. The Credit department your company's last two years audited Financial Statements -- both Balance Sheet and Profit and Loss Statement.

Bank Reference: Telephone:

Address:

City: State: Zip Code:

Account No : Main Contact:

Commercial References:
Please include up to 4 (four)
name address city state zip phone fax email

I/We, the undersigned, acknowledge the information supplied is true, accurate, and complete. We authorize Duramax Inc. to contact any of the above references and authorize each of them to release all credit informatin necessary. The undersigned hereby releases Duramax Inc. and all above references from any responsibility or liability for the release of said information. We agree to pay all invoices in accordance with the terms of sale. We also agree to pay late charges on balances which become past due at the legal rate set by law and any reasonable attorney's fees and other costs of collection incurred by seller.

Company Name:
Signed By:
Title:
	Yes! Please contact me for a quote request.

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