Customer Account Application

Thank you for choosing Chase Fire Products Inc. We aim to set the bar for top notch service. As a new customer we need you to fill out the new customer application before we can service your business.

You have the option of filling out this form on our website or filling out a paper version of this form provided in PDF format and fax it to us at 718-383-8001

New Customer Application Paper Form

Customer Account App

New Customer Account Application

Legal Company Name*
DBA
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Website
Email
Tax Status*
- Taxable
- Non-Taxable
Federal ID #
Industry*
Please indicate your company's customer type for our records.
Business Type*
Primary Location*
BILL TO
Please fill out completely
Payment Terms*
- Cash On Delivery
- NET 15
- NET 30
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email
Service Location
Contact*
Contact person at service location
Service Location Address*
Street Address Address Line 2 City State ZIP Code
Service Location Phone*
Fax
Signers Name*
First Last
Signer's Business Title*
Signature*
I HEREBY AUTHORIZE CHASE FIRE PRODUCTS INC. TO SERVICE THE LOCATION LISTED ABOVE.

Customer Account App

BILL TO

Service Location