• Customer Questionnaire

  • Welcome to the AquaPhoenix family! Please take a moment to fill out our Customer Questionnaire. We tried to make it as painless as possible. This form captures all the information needed to set you up with an account. We will use this information to design your product labels, ship items to the right place, and get in touch with the right people. Contact us at (866) 632-1291 with any questions.


    Hey Educators – head over here to get started with AquaPhoenix Education.

  • 1. Company Information

  • 2. Contact Information

  • Billing - Accounts Payable

  • TERMS: Our standard terms are Net 30 for approved accounts. If you prefer, we can process payments at time of shipping using Visa, MasterCard, Discover, or American Express. Please call the accounting department at 1-866-632-1291 to provide your credit card information.

  • Purchasing

  • Additional Contact

  • 3. Private Labeling

  • 4. Shipping Information

  • If freight collect:

  • LTL Billing Address

  • Additional Information

  • Should be Empty: