• Education Customer Questionnaire

  • Welcome to the AquaPhoenix family! Please take a moment to fill out our Customer Questionnaire. This form captures all the information needed to set you up with an account and helps to ensure that we get in touch with the right people in your organization.

    Don’t hesitate to reach out to us if you have any questions at (866) 632-1291 or info@aquaphoenixsci.com.

  • 1. Institution

  • 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.

  • Shipping

  • Purchasing

  • Additional Contact

  • 3. Additional Information

  • Should be Empty: