New Account Application

Contact your representative (find the list here) to initiate the process of opening an account with Jefferson. Your representative has a fillable PDF form, if you prefer to provide your information in that way.

Items with “*” are required.

Please fill in our form

 

Applicant Information

    • Sold to Address

    • Mailing / Billing Address (if different than "Sold to")

 

Company Principles

    • Principle 1

    • Principle 2

    • Principle 3

 

References

    Reference 1

    • Reference 2

    • Reference 3

    • Reference 4

    • Bank Reference

  • Please click the "Submit" button below to send this form to our office.
 

Verification

OUR INFORMATION

Jefferson Electric / Bemag

9650 South Franklin Drive

Franklin, WI 53132-8847

Email Customer Service

Customers from US and Canada should use the following telephone and FAX numbers:

Telephone: 414-209-1620

Toll Free: 800-892-3755

Fax: 414-209-1621

Toll Free Fax: 800-942-5169

Note: Division Headquarters is located in the Central Tim Zone and normal business hours are 8:00a.m. until 5:00p.m.

For a list of other departments, click here.

ABOUT US

Our History