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# Product Code Quantity
Boiler and Cooling Towers
Centrifugal and Drum Transfer Pumps
Chemical Feed - Metering Pumps and Accessories
Chlorine DO Turbidity
Conductivity and Resistivity
Flow Meters
Level Controls
pH and ORP
Multi-Parameter Control
Temperature and Pressure
Tanks and Containment
Valves and Actuators
Hand-held Water Quality Meters

Pumps, Instrumentation & Controls for Water Treatment

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Credit Application

To set up a customer account with net 30 terms (subject to credit review and approval), please fill out the application form below. Filling out an application is easy and usually takes less than 10 minutes.

If you have any questions, please contact our corporate offices at 888-265-5632, or email us at

If granted credit, I agree to pay all invoices according to your terms of Net 30 days, Accent Control Systems reserves the right to cancel applicant’s credit at any time without notice. In the event Accent Control Systems commences litigation or employs attorneys in order to secure payment of any sums due it from applicant, the applicant agrees to pay attorney and/or collection expenses, plus interest at 1.5% per month (18% annually) in addition to balances owed. The undersigned acknowledges that the above agreement has been carefully read and that the applicant understands and agrees to the same.

* All fields marked with an asterisk are required to be filled out before the form can be submitted.

Business Information

Company Full Name
Company Phone Number
   Company Fax Number
Company Billing Address 1
   Company Billing Address 2
Company City
Company State / Province
Company Zip / Postal Code
Company Country
Company Email Address
Company Contact
Years in Business
Product Sold/Mfg.
   D&B Number
Federal Tax ID
Type Of Business
How should we invoice you?
Mail to billing address
Email invoice to:
Fax invoice to:

Business Owners or Officers

  Name Title  

Trade References (Businesses currently selling to your firm)

  Reference #1 Reference #2 Reference #3 Reference #4
Name  *   *   *   * 
Fax  *   *   *   * 
Email  *   *   *   * 
Do You Qualify For State Sales Tax Exemption?   

If yes, please send us a copy of your sales tax exemption certificate:

Or upload a copy here: (PDF Required)

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