Page 75 - 2020 PMI Catalog

New Customer Information Form

** This is not a credit application
Please complete the form below in order to receive preferred customer
benefits from Performance Maintenance, Inc. All orders must be paid
Visit our Website: pmigogreen.com prior to or upon delivery. ** This form to be completed and submitted

along with PMI Credit Application to be considered for an on-going
Business Account.

Customer Details

Customer Name:

Company Name:

Address:

City: State: Zip:

Phone: Fax:

E-mail Address:

Website:

Is your company tax exempt? yes no PMI CRS#02-455124-00-4

If yes, please submit Nontaxable Transaction Certificate from NM Taxation and Revenue Dept.

Shipping/Delivery Information

UPS cannot ship to a P.O. Box.
Is your shipping/delivery address different from the above address: yes no
If yes, please complete the following:

Shipping/Delivery Address:

Attention:

City: State: Zip:

Sign & Date

__________________________________ _____________________________________ _____________
Signature Print Name Date