Become a customer

You must be logged in to see pricing and/or to place an order, if you haven't applied to be a customer of Nanotech Energy, please fill out the application below and we will respond to your request within 48 hours. If you are a current customer, please login here.

Representative Name*

Title*

BILLING INFORMATION

Company Name

Attention

Address

City

State

ZIP Code*

Phone*

Fax

E-mail*

Accounts Payable Contact*

Phone*

Fax

E-mail*

GENERAL INFORMATION

Principal/Owner/Officer*

Type of Business*

Phone*

E-mail*

EIN #*

INVOICING INSTRUCTIONS

Are written Purchase Orders required?

Invoice via e-mail address

TRADE REFERENCES (OR ATTACH INFORMATION SHEET)
*Upload your trade reference sheet here or complete the section below.

File Upload*

First Company Name

First Company Contact

First Company Address

First Company Phone

First Company Fax

First Company E-mail

Second Company Name

Second Company Contact

Second Company Address

Second Company Phone

Second Company Fax

Second Company E-mail

Third Company Name

Third Company Contact

Third Company Address

Third Company Phone

Third Company Fax

Third Company E-mail

Terms and Conditions: Completion of this credit application constitutes Applicant’s acceptance of Seller’s Terms and Conditions of sale, as set forth on the sellers website (www.nanotechenergy.com) and incorporated herein by reference. Applicant authorizes Nanotech Energy, Inc. to obtain credit and financial information concerning the Applicant at any time and from any source. The undersigned warrants that the above agreement has been carefully read and that the Applicant understands completely.

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User Email*

Password*

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