New Customer Form
Thank you for your interest in AK Scientific products! When placing your first order, please submit this form so we can process your order quickly.

To apply for net 30 payment terms, please fill in the bank/trade references. When ordering under net 30 terms, please provide your Accounts Payable billing information and a Purchase Order number.

For credit card payment or pre-payments, the bank/trade references may be left blank. To avoid delays in processing your order, please use our secure form to send your credit card information directly to our credit card processor: https://www.aksci.com/addcard

You may also download this customer setup form at http://www.aksci.com/forms/AKSci_New_Account_Setup.pdf and email or fax the completed form to us.

Company/Institution Name *
Your answer
Website *
Your answer
Description of Business Activities *
Your answer
Will your use of AK Scientific products only be for research and development use, performed by or under the supervision of a technically qualified individual, in a laboratory where exposure to those products are controlled by prudent laboratory practices regarding chemical substances of unknown toxicity? *
Owner Name, Title *
e.g. John Smith, CEO
Your answer
Federal Tax ID Number *
Enter N/A if none
Your answer
If your company is located in California, do you have a Resale Certificate? *
If yes, please e-mail or fax your certificate to us.
State Registration No.
Your answer
Year Established
Your answer
Number of Employees
Your answer
Type of Business
Billing Information
For NET 30 or prepayment terms, please provide the billing information of your Accounts Payable.

For credit card, please provide the billing information of your credit card and submit your credit card using our secure form: https://www.aksci.com/addcard.

PAYMENT TERMS *
How would you like invoices/credit card receipts to be sent to you? *
Street Address *
include Suite, Rm, Bldg, etc. if applicable
Your answer
City *
Your answer
State/Province *
Your answer
Country *
Your answer
ZIP/Postal Code *
Your answer
Accounting Contact Name *
"Accounts Payable" is acceptable
Your answer
Accounting E-mail *
Your answer
Accounting Phone No. *
Your answer
Accounting Fax No.
Your answer
Is the billing address a residence? *
Shipping Information
Your orders will be shipped to the below address, unless stated otherwise on your order.
Street Address *
include Suite, Rm, Bldg, etc. if applicable
Your answer
City *
Your answer
State/Province *
Your answer
Country *
Your answer
ZIP/Postal Code *
Your answer
Recipient's Name *
Your answer
Recipient's E-mail *
Your answer
Recipient's Phone No. *
Your answer
Recipient's Fax No.
Your answer
Is the shipping address a residence? *
Company Bank Reference
Please provide a bank reference for NET 30 term approval. This is not required for universities.
Bank Name
Your answer
Account No.
Your answer
Contact Name
Your answer
Contact Phone No.
Your answer
Trade References
Please provide two trade references for NET 30 term approval.
1. Company Name
Your answer
Account No.
Your answer
Address
Your answer
Contact Phone No.
Your answer
2. Company Name
Your answer
Account No.
Your answer
Address
Your answer
Contact Phone No.
Your answer
GENERAL TERMS & CONDITIONS OF SALE
PRODUCT INFORMATION
All product information, prices and availability are subject to change without notice. All prices are in U.S. Dollars.

RETURNS
Return shipments will NOT be accepted unless we have given prior permission and complete shipping instructions. Returns will not be accepted after thirty days from the original ship date.

PATENTS
AK Scientific's products may be covered by use or application patents. AK Scientific Products DOES NOT WARRANT that the use or sale of the products delivered hereunder will not infringe the claims of any United States or foreign patent or patent application covering the product itself or the use there of in combination with other products or in the operation of any process. The buyer is responsible for any patent infringement resulting from his use of our products.

TECHNICAL DATA
The physical properties and other data about our products are obtained from our own data and from literature references. AK Scientific assumes no responsibility for the accuracy or completeness of such data. Buyer agrees that he has the responsibility to fully determine the accuracy and completeness of any technical data concerning any product or use.

WARRANTY DISCLAIMER
No warranties by seller (other than warranty of title as provided in the uniform commercial code) shall be implied or otherwise created under the uniform commercial code, including but not limited to warranty of merchantability and warranty of fitness for a particular purpose.

LIMITATION ON CONSEQUENTIAL DAMAGES AND INDEMNIFICATION
Buyer acknowledges that there may be hazards associated with the use of certain products offered. Buyer agrees that their personnel concerned with any such product are aware of the hazards and assumes all responsibility for the warning of their employees and independent contractors of all hazards to persons and property in any way connected with the products, and Buyer agrees to instruct their employees, agents and customers to use safely such product. Buyer also assumes all responsibility for the results of using any product offered in combination with other articles or substances, and in any manufacturing process, and for the ultimate safe disposal of the product in accordance with applicable laws.

AK Scientific' sole obligation and the Buyer's exclusive remedy with respect to products proved to AK Scientific's satisfaction to be defective or nonconforming shall be return of such products to AK Scientific, and refund of the purchase price actually paid therefore by the Buyer. AK Scientific shall not be subject to any other obligations or liabilities, whether arising out of breach of contract, warranty, tort (including negligence and strict liability) or other theories of law, with respect to goods sold or technical services rendered by AK Scientific, or any undertakings, acts or omissions relating thereto. Without limiting the generality of the foregoing, AK Scientific specifically disclaims any liability for property or personal injury damages penalties, special or punitive damages, damages or lost profits or revenues, loss of use of product or any associated equipment, cost of capital, cost substitute products, facilities or services, down-time, shut-down, or slow-down costs, or for any other type of economic loss and for claims of the Buyer's customers or any third party for any such damages. AK SCIENTIFIC SHALL NOT BE LIABLE FOR AND DISCLAIMS ALL CONSEQUENTIAL, INCIDEN-TAL AND CONTINGENT DAMAGES WHATSOEVER.

The Buyer shall indemnify AK Scientific from and against any and all losses, damages and expenses (including attorney's fees and other costs of defending any action) that AK Scientific may sustain or incur as a result of any claim of breach of contract, tort (including negligence, breach of implied warranty, strict liability in tort) or other theories of law, by the Buyers, its officers, agents or employees, its successors and assigns, and its customers, or other persons, whether direct or indirect, in connection with the use of the product furnished hereunder.

Toxic Substance Control Act (TSCA)

AK Scientific does not warrant that its products are listed in the chemical substances inventory under the Toxic Substance Control Act (TSCA). The Buyer represents and warrants that the use of products purchased from Seller will be in full compliance with the act and its regulations.

CONDITIONS OF SALE
AK Scientific accepts buyer's orders solely upon the terms and conditions stated herein. Acceptance of buyer's orders is expressly conditional on buyer's acceptance of these terms and conditions.

Buyer's Acknowledgement
By affirming below, Buyer certifies that the information provided is true and correct. Buyer also, having carefully read all provisions of the above Terms and Conditions acknowledges receipt of, and agreement to the terms contained herein.
The information I provided is true and correct. I have read and agree to the Terms & Conditions. *
Buyer's Name *
Your answer
Buyer's Title *
Your answer
Date *
Your answer
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