Credit Application

General Information

Type of Business:  Corporation Partnership Proprietorship

Name of Business:

Email Address:

Office Address:

City: State: Zip:

Phone Number: Fax Number:

Owner/President:

General Manager:

Partners (if any):

Trade Information

Note: Please only list those vendors that sell to you on open accounts.

Name:
Account Number:
Address:
City: State: Zip:
Phone Number: Fax Number:

Name:
Account Number:
Address:
City: State: Zip:
Phone Number: Fax Number:

Name:
Account Number:
Address:
City: State: Zip:
Phone Number: Fax Number:

Vendor Information

Does your business require purchase orders?  Yes No

List name(s) of person(s) authorized to request service for your business.

Name: Title:
Name: Title:
Name: Title:
Name: Title:
Name: Title:

Terms and Conditions

1. All invoices are due on the 15th of the month following purchase of service.
2. All invoices past due after sixty (60) days shall accrue a finance charge of 1 1/2 % per month (18% per annum) on the past due amount.
3. In the event of non-payment, the customer agrees to pay all reasonable costs in securing full payment, including, but not limited to collection and attorney fees, including all court costs.

I have read and understand the above terms and conditions. I hereby certify that the business/corporation listed herein is licensed and authorized to conduct business within the State of Alabama.

Name: Title:
Email Address:
Home Address:
City: State: Zip:
Phone Number: Fax Number:

Enter the text below