Customer Set-up Forms (USA)

Customer Setup Form - Bank Card & Credit Terms (USA ONLY)

Step 1 of 9 - Select a payment method

Payment method*
- Bank Card (USA ONLY)
- Credit Terms (USA ONLY)
Are you an existing customer applying?*
- Yes
- No
Customer Number

Company Info
Company Name*
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping County*
Shipping Phone*
Shipping Fax
Billing Information Same as Shipping Address?*
- Yes
- No
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Billing County*
Billing Phone*
Billing Fax

Company Info (continued)
D & B No.*
Lab Type*
(Choose your company's lab type)
Hardy Account Manager
If you have spoken to a sales representative, please enter their name here. If not, leave blank.
Tax Exemption Status*
(Resale and Exempt require a certificate at time of application)
- Resale
- Exempt
- Taxable
Hidden
Tax Exemption Status*
(Resale and Exempt require a certificate at time of application)
- Resale
- Exempt
- Taxable
Upload your Tax Exemption Certificate*
Max. file size: 500 MB.
Estimated Monthly Purchase Amount:*
Please enter an amount greater than $1 and only enter the full dollar amount and not a range, thank you!

Contact Information
Laboratory Manager*
First Last
Phone*
Fax
Email*
Microbiology Supervisor*
First Last
Phone*
Fax
Email*
Purchasing Agent*
First Last
Phone*
Fax
Email*
Pricing Contact Email Address*
Order Confirmation Email Address*
Order Tracking Email Address*
Accounts Payable Supervisor*
First Last
Phone*
Fax
Email*
Invoice Email Address*

Ownership Information
Date Established
MM slash DD slash YYYY
Number of Years at this Address
Number of Employees
Business Type:*
- Corporation
- Individual
- Proprietorship
- Partnership
Hidden
Business Type:*
- Corporation
- Individual
- Proprietorship
- Partnership
Name of Owner/Officer
First Last
Owner/Officer's Job Title
Owner/Officer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner/Officer's Phone

Trade References
Please choose how you will complete your trade references*
- Upload your company's form
- Fill out fields on the next page
File*
Max. file size: 500 MB.

Trade Reference #1
Company Name #1*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Account Number
Name
Job Title
Phone*
Email*
Trade Reference #2
Company Name #2*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Account Number
Name
Job Title
Phone*
Email*
Trade Reference #3
Company Name #3*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Account Number
Name
Job Title
Phone*
Email*

Order Information
Do you have an immediate order to place?*
- Yes
- No
Attach Purchase Order here:
Max. file size: 500 MB.

Disclaimer:
In the event that any action is necessary to collect amounts due, Hardy Diagnostics will be entitled to recover all principal due as well as expenses and reasonable attorney fees. If you have any questions, please contact [email protected].
Terms and Conditions
All statements made herein are true and accurate to the best of our knowledge. We are aware that incomplete or false information may result in denial of credit. We authorize Hardy Diagnostics to make any inquiries necessary for action on this credit application. We agree to comply with the stated terms of sale, i.e. net 30 days. Any amount due after 30 days is subject to a late charge of 1.5% per month. In the event that any action is necessary to collect amounts due, Hardy Diagnostics will be entitled to recover all principal due as well as expenses and reasonable attorney fees. Hardy Diagnostics reserves the right to change credit terms at any time without notification. If you have any questions, please contact [email protected].
I have read and agree to the terms and conditions.*
- I Agree
Authorized Signature
Authorized Signature*
First Last
Date*
MM slash DD slash YYYY
Job Title*
Phone*
Email*

In closing I would like to pass along that since my first contact with Hardy Diagnostics mid last year, the services provided have been second to none. Hardy has been a great addition to my list of suppliers. Whether it be a friendly customer service rep that I speak to when calling in an order, talking with Cindy, or having the pleasure to work with someone such as yourself. I would like the thank you Cindy, and the ENTIRE Hardy team for always leaving me with a warm and fuzzy feeling no matter what the reason is for contacting. You guys are AWESOME!!!

Corey A. Foster
Quality Control Laboratory Technician

Customer Set-up Forms (USA)

Customer Setup Form - Bank Card & Credit Terms (USA ONLY)

Step 1 of 9 - Select a payment method

Company Info

Company Info (continued)

Contact Information

Ownership Information

Trade References

Trade Reference #1

Trade Reference #2

Trade Reference #3

Order Information

Disclaimer:

Terms and Conditions

Authorized Signature

The HardyBlog

News and Events

Customer Set-up Forms (USA)

Customer Setup Form - Bank Card & Credit Terms (USA ONLY)

Step 1 of 9 - Select a payment method

Company Info

Company Info (continued)

Contact Information

Ownership Information

Trade References

Trade Reference #1

Trade Reference #2

Trade Reference #3

Order Information

Disclaimer:

Terms and Conditions

Authorized Signature

The HardyBlog

MicroBytes Newsletter

News and Events