Parker PHconnect Application
YES! I want to apply for Parker Hannifin's PHconnect service. By signing and completing this document, I agrée to the standard terms and conditions of use listed on the back of this form.
Company Name:_
Company Address:_
City/State/Zip:_
Phone Number:_
YOUR COMPANY'S BILL-TO AND SHIP-TO LOCATIONS (PARKER SIX DIGIT CUSTOMER CODES) FOR WHICH YOU ARE REQUESTING PHCONNECT:
USERADMINISTRATOR:
(should be main user at this location; can also grant access to PHconnect features to other users at this location)
Name/Title:_e-mail address:_
Requested USER ID (i.e. Bobby123, LisaXYZ, etc.):_
ADDITIONAL USERS:
1) Name/Title:_e-mail address:_
Requested USER ID (i.e. Bobby123, LisaXYZ, etc.):_
2) Name/Title:_e-mail address:_
Requested USER ID (i.e. Bobby123, LisaXYZ, etc.):_
PERSON COMPLETING THIS FORM By signing and completing this document, I agrée to the standard terms and conditions of use listed on the back of this form.
Your Name: (PLEASE PRINT):_
Title:_
Signature:_