New Account - NBS Energy Services

All fields marked * are required. This application cannot be submitted unless all required fields are completed correctly.

Business Information

Legal Business Name*

DBA (If Applicable)

Physical Address*

City*
State*
Zip*

Billing Address (if different)

City
State
Zip

Phone*
Fax

Accounts Payable Email*

Company Website

Type of Business

Date Business Started
Years in Operation

Federal Tax ID (EIN)*
Dun & Bradstreet #

Owner / Officer Information

Owner / Officer 1 (required)

Name*
Title*

Phone
Email
% Ownership*

Owner / Officer 2 (required if Owner 1 is less than 100%)

Name
Title

Phone
Email
% Ownership

Bank Reference

Bank Name*
Contact Name*

Phone

Bank Address

Account Type
Account # (last 4 digits only)

Trade / Credit References (3 required)

Reference 1

Company Name*

Contact
Phone*
Email
Terms

Reference 2

Company Name*

Contact
Phone*
Email
Terms

Reference 3

Company Name*

Contact
Phone*
Email
Terms

Credit Request

Credit Limit Requested*

Preferred Billing Method
PO Required?*
Tax Exempt?

Billing Email for Invoices (if billing by email)*

Mailing Address for Invoices (if billing by mail)*

Terms & Agreements

Download NBS Standard Credit Terms & Agreement (PDF)

Authorization & Personal Guarantee

By submitting this form, I certify that the information provided is true and correct. I authorize NBS Energy Services LLC to verify references, obtain credit reports, and contact the entities listed above regarding credit and banking information. If credit is extended, I personally guarantee payment of all amounts due. I acknowledge that I have read and agree to the NBS Standard Credit Terms & Agreement.

Digital Signature (Required)

Type your full legal name below. This will serve as your digital signature.

Signature – Printed Name*
Title*
Date*

I have downloaded, read, and agree to the NBS Standard Credit Terms & Agreement and personally guarantee payment.