Shield Industries, Inc. is the manufacturer and marketer of the finest chemical maintenance products. We sell direct to Retailers, Wholesalers, Industrial and Institutional entities. On rare occasions, Shield Industries will address the needs of an individual consumer via our on-line shopping cart in instances where our product(s) are not readily available.

 

For New Commercial Customers Please Complete The Form Below.
 

There are multiple ways for you to complete this form for Shield Industries, Inc. 
 

You can call us direct at (800) 332-6327 or (770) 517 6869.
 

If you prefer, you can fill it out and print this form and fax it to us at (770) 517-6863.
 

Either way, we at Shield Industries are pleased to welcome you to our growing list of valued Customers. If we have not contacted you within 3 business days, please call us (770-517-6869) to verify receipt of your inquiry.

New Customer Information Form                                                                

Business Name:

d.b.a.: 

Bill to Addr1:

Bill to Addr2:

City: State: Zip:

Phone: 

Fax: 

E-Mail: 

Primary Contact:

Secondary Contact:

Type of Business:

Resale Number::

Ship To Address (If Different from Above)

Ship To Co.:

Ship To  Name:

Ship To Addr1:

Ship To Addr2:

Ship To City: State:   Zip:

Ship To Phone:

Ship To Fax:

Trade References (3)

Company, Contact, Phone Number

Additional Comments/Questions

CORPORATE OFFICES


Shield Industries, Inc.
131 Smokehill Lane - Woodstock, GA 30188
(800) 332-6327 - (770) 517-6869 - Fax (770) 517-6863

Email: Marketing@shieldindustries.com
www.shieldindustries.com