New Account Form
Please fill out this form so our Accounts Receivables department can create your customer profile in our system and you can begin making purchases.
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Application Date: *
MM
/
DD
/
YYYY
Business Name *
Enter your legal business name or if you're a sole proprietor please enter your name here.
Please Select Your Entity Type *
FEIN (TAX ID)
Business Billing Street Address *
City *
State *
Zip Code *
Country
if outside of the United States
Company Phone *
Corporate Officer Name *
This could be the name of one of the owners of the business or name of the sole proprietor.
Corporate Officer Title *
Corporate Officer Phone Number *
Please enter the phone number where we can reach the corporate officer or sole proprietor.
Buyer Name:
If you have a dedicated person making purchases please enter their name.
Buyer Email Address
A/P Contact Name *
Please enter the name of the person who is in charge of your accounts payable department.
Accounts Payable Phone
Please enter a phone number for your accounts payable department if different from Main Company Phone
Accounts Payable Email Address *
Please enter an email address for your accounts payable department.
Is your company Tax Exempt? *
If yes please click the link below to submit your resale tax certificate.
Do you have an assigned Sales Rep?
Please click the link below to upload your Resale Tax Certificate (if applicable)
If you are going to purchase HVAC Equipment or Refrigerant please click below to upload your EPA Certificate.
If you have a DERM Permit please click the link below to upload it
BEFORE SUBMITTING THIS FORM
PLEASE MAKE SURE YOU CLICK ON THE LINKS ABOVE IF YOU NEED TO SUBMIT A RESALE TAX CERTIFICATE, EPA LICENSE, OR A DERM PERMIT.

THANK YOU.

ONCE YOU SUBMIT THIS FORM JESUS JORGE, OUR ACCOUNTS RECEIVABLE MANAGER WILL SEND YOU AN EMAIL LETTING YOU KNOW THAT YOUR ACCOUNT HAS BEEN SETUP IN OUR SYSTEM. IF YOU HAVE ANY QUESTIONS YOU CAN REACH HIM AT AR@SAEZDISTRIBUTORS.COM -OR- (786) 783-3279.
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