Close Out Account Request

Please use this form to close out accounts/ ship to locations / buy outs for direct paper & National Buy Back
Purchasing Dept: Remove from demand planning , Ops: Remove from predicted/monitored system.
Equipment: Check for open contracts and loaned equipment/QBL Monitor Movement
Credit Manager: Check open AR before inactivating.

Date*
MM slash DD slash YYYY
Customer Name*
City, State*
Account #*
Location #*
Customer registered in Anova My Tank App*
- Yes
- No
My Tank App email registered (yes= list email address /no= NA)*
Is this due to Buyout/Change of Ownership*
- Yes
- No
New Company Name / CID/LOC*
Person Making Request*
Phone
Delivering Warehouse*
RSM/Sales Manager*
Comments
Your Email*