PRODUCTS & SERVICES

New Account Credit Information
Type of Business
 Corporation 
 Partnership 
 Sole Proprietorship 
Will a purchase order number be required?
 Yes 
 No 
Company Name
Date

MM 		/
DD 		/
YYYY
Manager or Contact

First
Last
Billing Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone

### 		-
### 		-
####
Fax

### 		-
### 		-
####
Email
Type of Business
How Long in Business
Tax Exempt #
Tax Exempt Certificate: File Upload
Sales Tax Rate %
% State
% City
Bank Name
Bank Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Bank Phone

### 		-
### 		-
####

Business References (Open Account)

Please list at least three.

1.

Name
Account #
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone

### 		-
### 		-
####

2.

Name
Account #
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone

### 		-
### 		-
####

3.

Name
Account #
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone

### 		-
### 		-
####
Read Carefully:
I agree to keep within your terms if granted an open account. Should this account ever become delinquent and it becomes necessary to employ an attorney to collect or commence suit to enforce payment, I agree to pay a reasonable additional sum as attorney fees; also cost of such suit if necessary. Principal and interest payable in lawful money of the United States.

TERMS: NET 30 days from date of invoice, and 1.5% FINANCE CHARGE on invoice dates 31 days and older.
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