New Account Credit Application
Firm Name:
Firm Address:
City:
State:
Zip:
Business Phone:
Home Phone:
Business Type:
Individual
Partnership
Corporation
Email:
Date Business Started:
Years At Present Address:
State Sales
Tax Number:
Names of Officers or Owners
:
Name:
Home Address:
Name:
Home Address:
Bank Name:
Account Number:
Supplier & Credit Information:
Name
:
Phone:
Address:
Name
:
Phone:
Address:
Name
:
Phone:
Address:
Please Read Before Typing Signiture
We, the undersigned, understand your account terms are net 30 days from date of invoice. We hereby personally guarantee payment of any indebtedness from the applicant. Each of us further agree that in the event of default on this account, we are to pay reasonable collection costs, including all attorney's fees. The above information is for the purpose of obtaining credit and is warranted to be true.
Signature:
Date:
OR
Print and fax/mail to the address below.
P.O. Box 906
, Indian Rocks Beach, FL 33785
Phone: 1-888-277-9590 Fax: (727) 596-8336
P.O. Box 906, Indian Rocks Beach, Florida 33785-0906
Phone: 1-888-2779590 Fax: (727) 596-8336
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