Download PDF Version New Customer Application Form Company Name:* DBA: Address: Date: MM slash DD slash YYYY NAICS: City, State/Province, Postal Code, Country: Phone:Email: Fax: Website: Type of Business: OEM/MFG Distributor MRO Military/Aerospace Other Customer ContactsFunctionNamePhoneEmailAuthorized Purchase Accounts Payable Controller/Finance Engineering Manager Sales & Marketing Mgr. General Manager PSP Seals Contacts Function Name Email Requests for Quote Greg Blakely Margot Newman Wyatt Sorg [email protected]PSPseals.com Orders Greg Blakely Margot Newman Wyatt Sorg [email protected] Controller Lee Mueller [email protected] Director of Finance Tony Dee [email protected] Engineering Mark Gustin [email protected] Director of Sales Charles Carrel [email protected] General Manager Bill Walls [email protected] OPERATIONS1. Product to be supplied: OEM Parts Only Form, Fit, Function Other other product to be supplied 2. Stocking Required? Yes No 3. Revision Control? Yes No 4. Custom Labeling Requirements? Yes No If yes please explain 5. Special Packaging Requirements? Yes No If yes please explain 6. Special Shipping Documents Required? Yes No If yes please explain SHIPPINGMethod of Shipment: Prepay Freight Collect Carrier Account# Special Requirements: Shipping Address (If different than above):Company Name: Address: City, State, Zip: Phone: Fax: Company Name: Address: City, State, Zip: Phone: Fax: GOVERNMENT BUSINESS CLASSIFICATIONSelect all that apply: Small Business Large Business CAGE Code: # ITARS Compliant/Certified Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Veteran Owned Business (VBE) Service Disable Veteran Owned Business (DVBE) Other Thank You for the Opportunity to Earn Your Business Please Return the Completed Form via: Email: [email protected] Fax: 260.436.9046 Mail: PSP Seals, LLC 3702 Vanguard Drive, Fort Wayne, IN 46809PhoneThis field is for validation purposes and should be left unchanged.