Nelsen

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New Account & Catalog Request

Thank you for considering Nelsen Corporation as your supplier!
Nelsen Corporation is a wholesale distributor whose sales policy is to sell only to professional dealers who sell, install and/or service any material purchased from Nelsen Corporation. All potential customers must be qualified before receiving a catalog and establishing an account.

As a professional dealer, we hope you understand and respect our policy and the need to qualify each company requesting information from Nelsen Corporation.

Company Information

Company Name
Mailing Address
City
State
Zip

Please Send Catalog

Shipping Address:
City:
State:
Zip:

Nelsen Corporation has the ability to email invoices to your Company rather than sending them via US Mail. Please provide the email address for your Accounts Payable Contact.

Buyer/Contact Name
Buyer/Contact Phone Number
Buyer/Contact Fax Number
Buyer/Contact E-mail Address

Accounts Payable/Contact Name
Accounts Payable Phone Number
Accounts Payable eMail

Purchasing Information

As a wholesale only distributor representing over
4,000 products from 200 vendors, we would like to
understand how we can best serve you. The answers
to the following questions will enable Nelsen Corporation to quickly expedite your application, qualify your account with our Company and understand the types of products that you use.

Product	YES	NO	Estimated Qty Sold/Month
Water Softeners
Water Filters
Chemical Feed Pumps
Ultraviolet Systems
RO Systems
Engineered Systems
Water Well Pumps

Form Completed by:

For Office Use Only

Preferred Suppliers

COMPANY NAME
Estimated Annual Purchases
COMPANY NAME
Estimated Annual Purchases
COMPANY NAME
Estimated Annual Purchases

Preferred Brands

Please Fax this Completed Form to 330.745.1056 or email using the button below.

NELSEN CORPORATION

3250 Barber Road • Norton, OH 44203	5701 W. Latham St. #107 • Phoenix, AZ 85043
Phone: 800.362.9686 Fax: 888.544.8780	Phone: 866.445.4299 Fax: 602.442.0447