COMPANY INFORMATION

Date:

Federal ID#:

Sales #:

Company Name:

Phone:

Fax:

Address:

City

State:

Zip Code:

Accounting Email Address(es):

Special Billing Instructions:

E-mail(s) for Invoices

Type of Ownership:
CorporationPartnershipSole Proprietorship

Date Company Started:

Owner and/or President:

Cell Phone:

Social Security #:

Home Address:

OTHER OWNERS/PARTNERS

Name:

Cell Phone #:

Home Address:

Name:

Cell Phone #:

Home Address:

COMMERCIAL BANKING REFERENCES:

Bank:

Contact:

Address:

Phone:

Type of Accounts:
Business CheckingPersonal CheckingSavingLoan

CREDIT REFERENCES

Name:

Phone:

Email/Fax:

Address:

Name:

Phone:

Email/Fax:

Address:

Name:

Phone:

Email/Fax:

Address:

Should it become necessary to place this account with an attorney for collection, suit, or other legal action, I/We with this agree to pay all costs of such collection, suit, or other legal action, including attorney's fees and costs.
Applicant understands that all purchases are due net within 15 days from purchase. Applicant further understands and agrees that service charges of 1.5% per month will be added to the balance if unpaid one month from the closing of statement.

Accounts 30 days Past Due will automatically go to C.O.D

Authorized Signature:

Title:

Personal Guarantee:

Title: