Thank you for your request to open an account with Dale Oxygen, Inc.In order for us to open an account, we need the following information:Company (or name if individual):* Mailing Address:* Building or Suite Number: City:* State:* Zip Code:* Shipping Address:* Building or Suite Number: City:* State:* Zip Code:* Phone Number:* Fax Number:* Email Address:* Tax Exempt #: Copy of Tax Certificate Needed for FilesMax. file size: 128 MB.EIN or Social Security #:* Contact Person in Accounts Payable:* Accounts Payable Email Address:* Contact Person in Purchasing:* Puchase Order Required?* Yes No Blanket Number: Employer (if individual): What Products and Services Will You Require?* Three Trade References1. Company Name:* Address:* City:* State:* Zip Code:* Phone Number:* Fax Number:* Email Address:* 2. Company Name:* Address:* City:* State:* Zip Code:* Phone Number:* Fax Number:* Email Address:* 3. Company Name:* Address:* City:* State:* Zip Code:* Phone Number:* Fax Number:* Email Address:* Bank ReferenceBank:* Address:* City:* State:* Zip Code:* Phone Number:* PhoneThis field is for validation purposes and should be left unchanged.
