Enrollment Form | Applied.com

Industries > ... US Communities > Enrollment Form

Applied Industrial Technologies (Applied^®) / U.S. Communities Enrollment Form

Completion of this document is required to add AppliedIndustrial Technologies as on of your U.S. Communities suppliers and receive U.S. Communities pricing on Applied Industrial Technologies products and services.

NOTE: This document also affirms that the registered agency has also registered for the U.S. Communities program at www.uscommunities.org.

Based on this registration, we will track all sales on your accounts for both compliance and rebate tracking as per our Contract #11019 with Maricopa County, AZ.

Procurement cards and Purchase Orders may be used as a form of tender; we will link each registration to an Applied^® account for tracking purposes.

Please review form for accuracy before submitting! Errors will result in an invalid form.

I have registered with U.S. Communities	Yes No
If no, you must register with U.S. Communities before you can benefit from the Applied-U.S. Communities partnership.	Please copy and paste this URL into your browser to register now: http://www.uscommunities.org/register/start-registration.aspx
Agency Name:
Agency Type
Tax ID#: (eg. 123456789)
Department:
First Name:
Last Name:
Street Address:
City:
State:
Zip code:
Phone:
eMail:
Are you an Applied customer?	Yes No
If yes, please enter your Applied account number:
If no, would you like to be registered to purchase on Applied.com?	Yes No
Subscribe to state/local e-newsletter from Applied.	Yes No

Applied Industrial Technologies does not sell or share e-mail addresses or any other personal information with other companies, marketers, magazines or any other third parties. From time to time, we may send you e-mail regarding promotions or important news unless you opt-out of e-mail communications.