First Name

Last Name

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Restek Account #

Username

First Name

Last Name

Telephone Number

Password

Passwords must be at least 6 characters in length and must contain at least one lowercase letter (a–z), one uppercase letter (A–Z), one numeral (0-9), and one non-letter/non-digit special character (e.g., *, !, #, etc.).

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Testers - Do not fill out this form. Select Full or Light registration options below:

EZ SUITE USERS: If you do not know or have a Restek account number, sign up today. Credit

Register for an Online Account and Access

Username

First Name

Last Name

Telephone Number

Password

Confirm Password

Company Name

Address

Address 2

City

Country

State / Province

Postal Code

Billing Information

Billing Contact Name

Billing Contact Email

Telephone Number

Address

Address 2

City

Country

State / Province

Postal Code

Invoice Delivery Preference

Mail Paper Copy Email

Company Website

Do you plan to export Restek products?

YES NO

Doing Business As (DBA)

W-9

Upload your W-9 or other acceptable document using the box below. You can continue to fill out the rest of this application while the file is being uploaded.

Choose file(s)

Sales Tax Status

TAXABLE EXEMPT

Rewards Program

Are you interested in participating in our Restek Rewards Program?

YES NO

Apply for Credit Terms?

YES NO

I agree to receive marketing and educational communications from Restek. (You may unsubscribe at any time in the future by visiting https://www3.restek.com/Unsubscribe)

Do you plan on submitting quote requests or purchasing product online?

Yes, continue with full registration

At Restek, we understand and respect your concerns about the privacy and security of your personal data; for more information, visit www.restek.com/row/pages/privacy-policy/.

If you have a question about your registration, email Restek Customer Service or call us at 1-800-356-1688 (ext.3) or 1-814-353-1300 (ext. 3).

Company Name

Federal Tax ID #

Business Type

Years in Business

Number of Employees

NAICS Code (optional)

TAXABLE EXEMPT

Invoice Billing Information

Company Name

Address

Address 2

City

Country

State / Province

Postal Code

PO Box

Telephone Number

Fax Number

Accounts Payable Contact Details

Contact Name

Telephone Number

Fax Number

Trade / Credit Reference 1 of 2 (Required)

Contact Name

Company Name

Address

Address 2

City

Country

State / Province

Postal Code

PO Box

Telephone Number

Fax Number

Trade / Credit Reference 2 of 2 (Required)

Contact Name

Company Name

Address

Address 2

City

Country

State / Province

Postal Code

PO Box

Telephone Number

Fax Number

In providing the above credit information, the applicant authorizes Restek to contact all companies given as references and to make other credit inquiries. Restek’s payment terms are Net 30 days. Restek retains the right to charge 1.5% late charge after 30 days. It is understood that no additional deliveries can be made when an account is delinquent. In the event of a default in payment, applicant agrees to be responsible for all cost of collection, including, but not limited to, collection agencies fees, attorney’s fees, and court costs.

19 September 2021

Authorized Signer

By clicking "Submit Credit Application," I affirm that I legally own this business or that I am authorized to apply for credit on its behalf.

Register for an Online Account and Access

Register for an Online Account and Access

Billing Information

Choose A Distributor

Do you plan on submitting quote requests or purchasing product online?

Credit Application

Invoice Billing Information

Accounts Payable Contact Details

Trade / Credit Reference 1 of 2 (Required)

Trade / Credit Reference 2 of 2 (Required)

Your Light Registration Has Been Completed

Your Full Registration Has Been Submitted