Electronic New Account Application

    If you have all your company information in a separate file, you may upload it here:

    You can also email the file to newaccounts@mrjohnpit.com or fax it to 412-927-1290.

    *Company Name:

    Phone:

    Website:

    Billing Address:

    Shipping Address:

    Type of Business:

    DBA (if applicable):

    Year Founded

    Federal Tax ID #:

    Purchase Order Required:

    Monthly Statement Required:

    Preferred Invoice Delivery:
    Purchasing Information

    Purchasing Contact:

    Purchasing Phone:

    Purchasing Fax:

    Purchasing Email:

    Accounts Payable Information

    A/P Contact:

    A/P Phone:

    A/P Fax:

    A/P Email:

    Ownership Information

    Owner/Officer Name:

    Title:

    Trade References (3 Required)

    Company Name:

    Contact:

    Phone:

    Fax:

    Email:

    Company Name:

    Contact:

    Phone:

    Fax:

    Email:

    Company Name:

    Contact:

    Phone:

    Fax:

    Email: