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

CUSTOMER ACCOUNT APP

New Customer Account Application

Legal Company Name*

DBA

Address

Street Address Address Line 2 City State Zip Code

Phone

Website

Tax Status*

Taxable

Second Choice

Federal ID #

Industry*

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

SERVICE LOCATION

Contact*

Service Location Address*

Street Address Address Line 2 City State ZIP Code

Service Location Phone*

Fax

Signers Name*

First Last

Signer's Business Title*

sales@chasefire.com

10-46 47th Ave. LIC, NY

call us now
(718) 383 8000

CUSTOMER ACCOUNT APP

New Customer Account Application

BILL TO

SERVICE LOCATION

CERTIFIED COVERAGE IN –

Fully Insured & Certified 20+ Years

Address

Chase Fire Services