New Customer Application - Kappus Company

Welcome to Kappus Company!

We are happy to have you on board and look forward to providing all of your equipment, parts and service needs. Please complete the information below to establish your organization/store location as a Kappus customer. A member of our team will review the information provided and reach out with questions, additional information required, and confirmation of account set-up.

If you have any questions, please reach out to our customer service team at 800.441.8089 or service@kappuscompany.com.

Kappus New Customer Application

Date(Required)

Applicant Name

Applicant Job Title

Business Name(Required)

Applicant Phone(Required)

Applicant Email(Required)

Service Contact Name(Required)

Service Contact Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Billing Contact Name(Required)

Billing Contact Email(Required)

Is PO Required for Orders?(Required)

YES

If You Would Like to Set a Credit Limit for Your Account, Please Specify the Dollar Amount

Site Name(Required)

Site Address (if different than billing address)

Street Address Address Line 2 City State ZIP Code

Site Contact(Required)

Site Phone(Required)

Site Contact Email(Required)

Current Units at Site To Be Serviced

Unit 1 - Manufacturer Name

Unit 1 - Full SKU

Unit 1 - Serial Number

Attach Picture of Data Label

Max. file size: 256 MB.

Unit 2 - Manufacturer Name

Unit 2 - Full SKU

Unit 2 - Serial Number

Attach Picture of Data Label

Max. file size: 256 MB.

Unit 3 - Manufacturer Name

Unit 3 - Full SKU

Unit 3 - Serial Number

Attach Picture of Data Label

Max. file size: 256 MB.

Unit 4 - Manufacturer Name

Unit 4 - Full SKU

Unit 4 - Serial Number

Attach Picture of Data Label

Max. file size: 256 MB.

Tax Exemption Certificate(s)

Please attach tax exemption certificate(s), dependent on which state the site/ship to is located.

File

Max. file size: 256 MB.