The Benefits of Login - Set-up a New Account

We deliver personal service.... although we'd love to talk, sometimes it's easier and faster for you to apply on line. After submitting to us we will respond personally to you within 48 hours.

Welcome aboard and we look forward to talking.

Fill in the form below to apply for an account with Unique Gas Products.
Fields marked with "*" are required fields.

Full Name of Business:    *
Address:    *
City:    *
Province/State:   
Country:    *
Postal/Zip Code:    *
Telephone:    *
Fax:    *
 
Chief executive/director:    *
Address:   
Registered/head office:   
Telephone:    *
Fax:    *
 
Number of years in business:    *
Annual Sales:    *
Credit line requested:    *
 
Bank:    *
Branch:    *
 
* one of the two following fields is required
US Customers - IRS #:   
CDN Customers - PST #:   
 
Trade references (state: name, address, phone & fax numbers)
Reference 1:    *
Telephone:    *
Fax:    *
Reference 2:    *
Telephone:    *
Fax:    *
Reference 3:    *
Telephone:    *
Fax:    *
 
Your Email Address:    *
First Name:    *
Last Name:    *
Position with Company:    *
 
    
    
If you prefer to mail or fax us your account information, please select the appropriate link to download a printable version of the form: US version or Canadian version.
    
To login, click here.