Company Name:              Number of Years in Business:

Type of Business:                         Phone: Fax:

Purchasing Contact:            Phone: Fax:
           Email Address:

Accounts Payable Contact:Phone: Fax:
           Email Address:

 Bill to address:       

                        City:   State:   Zip: Country:

D&B #:               Other Email Address:

Ship to address:

                      City:   State:   Zip:   Country:

Home Office

Address:      Phone:  Fax:

        City:   State:   Zip:   Country:

 Credit Information:

Bank Name:         Contact:

Bank Address:     Phone: 

                      City:   State:   Zip:    Country:

Please Provide Four Credit References:

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

ALL CREDIT INFORMATION SUPPLIED WILL BE KEPT CONFIDENTIAL

Please note that as an added service we accept the following major credit cards:
                                                American Express, Visa and Master Card

Tax Information   (Exemptions)

                               State: ? Yes No NA          County or Parish: ? Yes No NA                           City: ? Yes No NA         

NOTE: If exempt, please furnish us a copy of your tax certificate for our records.

Our Remit to address is:  Piping and Equipment, Inc.
                                               P.O. Box 644297
                                               Pittsburgh, PA  15264-4297  

Please Note:  When you press the "Submit Form" button, this application will be sent via email to our corporate headquarters and will be kept strictly confidential.  You will be notified within 24 to 48 hours after this application is received.

Thank you for taking the time to set up an account with our company.  We are excited about this opportunity to do business with you!

Amount of Credit Line Requested:

Please enter your email address:

  F-040 Rev. 6      2/14/2008