New Customers - Lumaco Sanitary Valves

Name (as appears on W-9) *

Business Name/dba (if different from above)

Are purchases made by your company eligible for a Sales Tax Exemption? *

Yes, purchases are Sales Tax Exempt
No, purchases are not Sales Tax Exempt
N/A - purchases are ONLY shipped internationally and are not subject to Sales Tax

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Principal Business Address (Please no PO Boxes) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Principal Business Telephone

Principal Business Fax

Is the above address also the Mailing Address? *

Yes, please use the Principal Business Address for all physical correspondence
No, please use the following Business Mailing Address

Business Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Website *

Primary Purchasing Contact Name *

First

Last

Primary Purchasing Contact Address *

Primary Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Purchasing Contact Telephone

Primary Purchasing Contact Fax

Primary Purchasing Contact Email

I allow my email address to be used for Lumaco News & Events announcements *

Yes, please add my email to your mailing list for important announcements such as price changes
No, please do not add my email to your mailing list

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Do you have a Secondary Purchasing Contact that you would like to include? *

Yes, please add the Secondary Purchasing Contact below
No, please use only the Primary Purchasing Contact

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Customer Payment Terms

Payment Terms Requested *

Prepay: payment in full prior to shipping
Credit Account: 1/2% 10 Days, 30 Days Net

Payment Method *

Check/Money Order/ACH
Credit Card
Wire Transfer

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Credit References

Credit Reference #1 *

Business Name

Credit Reference #1 Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

A/R Contact #1 Name *

A/R Contact First, Last Name

A/R Contact #1 Phone *

A/R Contact Phone

A/R Contact #1 Email *

A/R Contact Email

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Credit Reference #2 *

Business Name

Credit Reference #2 Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

A/R Contact #2 Name *

A/R Contact First, Last Name

A/R Contact #2 Phone *

A/R Contact Phone

A/R Contact #2 Email *

A/R Contact Email

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Credit Reference #3 *

Business Name

Credit Reference #3 Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

A/R Contact #3 Name *

A/R Contact First, Last Name

A/R Contact #3 Phone *

A/R Contact Phone

A/R Contact #3 Email *

A/R Contact Email

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Customer Billing Information

Accounts Payable Contact Name *

First

Last

Accounts Payable Contact Phone *

Accounts Payable Contact Email *

Preferred invoicing method (choose one) *

Email
Fax
Mail

Please provide the billing address where paper invoices should be sent *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Lumaco Customer Appreciation

At Lumaco, we have created a tradition out of designing custom T-shirts to show our customers how much we appreciate them! At the end of the year, we are delighted to send qualifying customers free T-shirts (other merch is in the pipeline!). Who will be the lucky recipient? *

Please send Lumaco merch to the following contact at the address below
No thanks, we are not interested in quality, custom Lumaco merch

Customer Appreciation Mailing Address (Please no PO Boxes) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

New Customer Account

Lumaco does not collect and remit sales tax on behalf of our customers. Please contact our Sales Team at sales@lumaco.com for a list of Distributors in your area.

Lumaco News & Events will also be posted on our website at http://www.lumaco.com/news-events/

Lumaco News & Events will also be posted on our website at http://www.lumaco.com/news-events/

Customer Payment Terms

Wire Transfer Payment and Fee Conditions

Credit Account Application

Credit References

Permission to Contact Bank and Credit References

Customer Billing Information

Lumaco Customer Appreciation