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Shelco Distributors Account Application

This application is required to get your pricing even when using the Credit Card Only option. You will be sent an email on approval and then can begin using your login name and password. Please wait for that approval email.

Form items in red with an * are required entries.

Company Name
Address
Country
City
State
Zip
\Business Type
Check if you are currently an authorized Modine Distributor

User 1 Email
User 1 Password

User 2 Email
User 2 Password

User 3 Email
User 3 Password

Credit Card Only (check this if you will only pay with a credit card)
Credit Limit Desired

Credit Information (Section applies if requesting a credit limit)

Name
Phone
Fax
Contact

A/P Contact
A/P Phone
A/P Fax

Tax ExemptIf checked, Tax ID required
Tax ID Number
Business Form
Date Started
Owner Name
Owner Email
Web Site

Applicant agrees to pay all charges within 30 days from invoice date. Applicant understands and agrees that payment is in accordance with agreed upon terms and is not contingent on applicant's receipt of payment from any other party for goods or services or for any goods or services provided by Shelco Distributors. All late payments (those received 45 or more days after invoice date) shall be subject to a service charge of 1.5% per month, which is an annual percentage rate of 18%.

By filling out the Authorized Name and Date in this section and clicking on the Submit button, you agree to the following:

You are authorized to fill out and submit this form.
You certify that all informantion provided is true and correct. Email
You agree to abide by the "Credit Terms & Conditions" above. Date

Authorized Name
Email
Date