Company Information

Billing

Purchasing

Owner or Partners

Supplier References

Please provide four suppliers who can give us credit references.

Signature

By submitting this form, you attest to your financial responsibility and your ability and consent to pay amounts owing on the account in accordance with our terms of sale: NET 30 days. Please note that the first three orders are payable upon receipt. You also authorize AKUJET TECHNOLOGIES INC to make inquiries with the bank and suppliers mentioned above.