NEW ACCOUNT  FORMS

Download, complete, and return the following forms.

  1. Customer Profile Form

  2. W-9 Form 

  3. Credit Application *(Disregard if preferred method of payment is by credit card)

Return to saferlock@att.net or by fax at 601-353-0411 with New Account Setup in the Subject Field or Attention Line.     

 

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

                           1.                                                          2.                                                      3.*

Have a question?

601-353-3193 ext. 215 or 

DESIGNED | SUPPORTED | MADE

IN THE USA

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United Plastic Molders, Inc.

© 2020 Safer Automatic Wheelchair Wheel Locks, a division of United Plastic Molders, Inc., 105 E. Rankin Street, Jackson, Mississippi 39201