New Customer Setup / Credit Application

*Denotes required information.

New Customer & Credit Application (New)

Name of Person Completing Form

Email of Person Completing Form

Business Name

Address

City

State/Province

Zip/Postal

Shipping Address Same as Billing

Shipping Address is Same as Billing

Shipping Address

City

State/Province

Zip/Postal

Phone

Year Established

A/P Contact Name

A/P Email Address

A/P Contact Phone

If you are human, leave this field blank.

REI Corporate Office | North Carolina

2052 Industrial Drive, Newton, NC 28658
704.325.3535 / 888.734.3783

REI Texas Location

5201 Pyramid Blvd, Fort Worth, TX 76126
817.560.1082

REI Indiana Location

1733 E Division Rd | La Porte, IN 46350
219.324.0500

AES / REI Pennsylvania Location

535 Hagey Road, Souderton, PA 18964
215.723.7200

Company

Equipment & Services

Types of Equipment