Register

New Client Registration Form

You’re on your way to purchasing filters easier than ever before. Fill out the information below to register. Once registration is complete and verified you will be able to purchase air filters on the E&I membership level.

Institution Name

E&I Membership ID #

What type of institution?

Billing Information

Please fill out the point of contact for all Billing inquiries.

First Name

Last Name

Billing Phone #

Billing Email

Tax ID #

Billing Fax #

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Facilities Information

Please fill out the point of contact for all Facility inquiries.

First Name

Last Name

Facilities Phone #

Facilities Email

Facilities Fax #

Shipping Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Purchasing Contact Information

Please fill out the point of contact for all purchasing inquiries.

First Name

Last Name

Purchasing Phone #

Purchasing Email

Are you Tax Exempt? (if yes, please upload tax exempt form)

Yes

What’s your fiscal year?

Tax Exemption Certificate Upload

Choose File

Method of Payment

Purchase Order

P – Card (will collect info at a later time)

If PO, please select frequency preference

Monthly

Yearly (blanket)

Per filter delivery

Not sure yet

Note:

New accounts are reviewed before creation. This may take several days. After your new account gets created, notification will be sent to your email address.