NEW ACCOUNT  FORMS

Download, complete, and return the following forms.

* Disregard credit application if preferred method of payment is by credit card .

Email to saferlock@att.net or fax to 601-353-0411.       

For additional information call 601-353-3193 x 215.

  1. Customer Profile Form

  2. W-9 Form

  3. Credit Application*

                     Customer Profile                                                W-9 Form                                         Credit Application

Have a question?

601-353-3193 ext. 215 or 

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FAQ

DESIGNEDSUPPORTED | MADE

IN THE USA

FDA & SAMS Registered as

United Plastic Molders, Inc.

© 2019 Safer Automatic Wheelchair Wheel Locks, a division of United Plastic Molders, Inc., 105 E. Rankin Street, Jackson, Mississippi 39201