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APPLY FOR AN ACCOUNT

Please fill in the following and click on the submit button.
My Account:
Account #
Important! If you are already an Imperial customer please enter your account number here. If you are not a current customer, you will need to fill in the shipping and billing information sections of this form. If you do not know your account number, but are an Imperial customer, please contact your Imperial sales representative to be set up with an online account.

Contact Info:
*Contact Name
*Contact Title
*Company Name
*Phone
*E-mail Address
*Password  Minimum of 5 characters
This password is the initial one used to access the e-commerce system. After your initial login you should change the password using the change password function on the account profile page.

Demographic Information:
Maintenance Technicians
The number of shop techs at this entire location.
Trucks Maintained
The number of trucks maintained at this entire location.
Trailers Maintained
The number of trailers maintained at this entire location.
Shop Locations
The total number of maintenance shops within this entire location.

Shipping Address Info:
Company Name
Street Address

Residential Address
Important! This address MUST be deliverable by UPS. This means the address must be street accessable by UPS delivery trucks, and NOT a PO box or other drop location!
City
State
Zip Code
Phone

Billing Address Info:
Company Name
Street Address

Residential Address
Important! If you do not fill this address, your shipping address will be assumed to be your billing address.
City
State
Zip Code
Phone

Additional Comments:
* = Required field (must be filled in to continue)
 

Imperial Supplies LLC does not provide services and products outside the United States

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