Contractor Credit Application

Contractor Credit Application

Business Name*

Business Address*

i.e. 1234 Main Street, Somewhere, NC 12345

Billing Address

(If different from above)

Phone Number*

Phone

Email Address*

Type of Business*

Fire

Plumbing

Irrigation

Other

Please explain:*

Attach Business W-9*

Drag and drop files here or

Does your business have a valid resale certificate?*

Yes

*Please attach your resale certificate with your W-9 above.

My resale certificate is attached.*

How many years has your business been established under the above name?*

How long has your business been at the above location?*

Does your business use purchase orders?*

Yes

Principle Owner(s) & Officer(s)

Please provide their name, position, address, phone number, and email address.

Name*

Position*

Address*

Phone*

Phone

Email*

Add another person

(2) Name

(2) Position

(2) Address

(2) Phone

Phone

(2) Email

Add another person

(3) Name

(3) Position

(3) Address

(3) Phone

Phone

(3) Email

Who are the 3 major sources of supply with whom you have open accounts?

1. Name*

1. Address*

1. Phone*

Phone

1. Email*

2. Name*

2. Address*

2. Phone*

Phone

2. Email*

3. Name*

3. Address*

3. Phone*

Phone

3. Email*

Have you ever filed bankruptcy?*

Yes

Please provide details:*

What is your approximate monthly credit request?*

I understand that all information provided herein is correct and is for the purpose of obtaining credit, and such information will be handled in confidence. Terms of payment are Net 30 days. Credit hold after 45 days. By checking this box, I have read and agree to the payment terms and conditions of this firm.

I agree to the above statement.*

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