B2B Application

Synergy Auto Wash Logo

Complete the form below to sign your company up for the Synergy B2B prgram. B2B members are billed at the end of each month.

Company Name*

Contact Name*

First NameLast Name

Contact Email*

Contact Phone*

Area CodePhone Number

Tax Status*

Non-Exempt (charge my company tax))Exempt (do not charge my company tax)

Tax Exempt Number

Additional Information