New Orleans 
Email NO Office

Baton Rouge 
Email BR Office

24-Hour Call-Out Service available
we accept visa, mastercard, american express & discovery

New Customer Credit Application


As a new customer with Atlas Hose and Gasket, please select one of the two following options regarding our credit application. 

Option 1: Atlas New Customer Credit App.xls (fill out in Excel and email or fax) 

Option 2: Atlas New Customer Credit App.pdf (print and fill out by hand)
Please email the credit application to or fax to 504-588-9912.
Atlas Hose and Gasket Company, LLC 
PO Box 57178
New Orleans, LA 70157-7178
  Telephone: (800) 522-9613 
Fax: (504) 588-9912 
1010 St. Mary Street
New Orleans, LA 70130