EPD New Customer Information Form

Company Name(Required)

First Name(Required)

Last Name(Required)

Credit Card Number(Required)

Expiration Date(Required)

CVV(Required)

Billing Address

Street Address(Required)

City(Required)

State(Required)

ZIP Code(Required)

Email(Required)

Website

Telephone(Required)

Shipping Address is the same as Billing Address

Shipping Address

Company Name

Street Address

City

State

ZIP Code

Telephone

Consent(Required)

I authorize and acknowledge the following:

• Energy Products Distribution (EPD) to charge the credit card provided above. I agree that this can be a one-time charge or a periodic charge based on future purchases or overdue balances associated with your credit terms.
• EPD and their sponsoring agency to run an address verification search. This verification process is a security measure to protect me, the client, from illegal fraud against my credit card.
• I guarantee and warrant that I am the legal cardholder for this credit card.
• I understand EPD’s return policies. (Our return policies can be found at the bottom of our various price lists.)
• Installation Training is non-refundable, even if you do not attend, unless the class has been cancelled by EPD.
• All orders will be shipped to the Shipping Address as stated above for all orders (present and future) unless stated otherwise in writing.
• EPD is not responsible for items that may be damaged, delayed, or lost by the shipping carrier. All shipments are insured with the respective carrier. All products and packaging should be carefully inspected upon receipt and any damage should be immediately brought to the carrier's attention. If any unacceptable damage as a result of shipping is found, the purchaser should alert the carrier and EPD that a claim needs to be filed for that shipment. Once a claim is approved and processed by the carrier, our shipping department will ship out replacement product or refund the purchase price. EPD has no control over the timeliness of the shipments and cannot be held responsible for any delays that occur while the package is being transported by the carrier, whether they are a result of the carrier's negligent actions or beyond the control of the carrier itself. If necessary, EPD will aid in the filing of an appropriate claim with the carrier in the event of the loss, damage, or delay of a customer's package.
• I will not file a dispute with my credit card company should any problems occur but will work with EPD for a mutually beneficial resolution.

EPD New Customer Information Form

Billing Address

Shipping Address

COMPANY INFORMATION

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