APPLICATION FOR CASH ACCOUNT

Application for Cash Account

This is an account set up request for a CASH ACCOUNT for Providence, RI and South Yarmouth, MA locations only. We are a wholesale provider of parts, supplies and equipment to HVAC and Refrigeration professionals. Identification is required of all purchasers.
REQUIREMENTS FOR OPENING AN ACCOUNT: An HVAC/R/E Trade License and an EPA 608 card representing the account is required and must be provided with this application.

The trade license and EPA card holder must be a current active employee. Trade Licensing is a State, Local and National code requirement for installing HVAC/R equipment. It is also required by the equipment manufacturer. The EPA 608 certification is a federal requirement for refrigerant handling which is essential for working with heat pumps and all AC equipment. Once you become an account holder, it is your reponsibility to keep your certification current in our system.
Name of person requesting account:*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Website Credential Requests:

Please go to our Website Credentials Request Form located on the website. Each person requesting credentials must have an approved account, submit for individual credentials, and must be listed as authorized to purchase under the account.
New Cash Account RequestExpress Locker Order Pick Up Providence Location Only
Cell Phone Number for Express Locker Set Up (Providence Location Only)
Express Locker Code will be sent to cell phone #
Business Name*
Business Phone Number*
Bill to Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bill to Address and Ship to Address are the SameShip to Address is Different than the Bill To Address
If Bill to and Ship To Address are the same skip next section
Ship To Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
BUSINESS INFORMATION
Business Type:*
EX: Mechanical Contractor, Commercial, Technician, etc.
Date Business Established*
12 to 56 - 910-2425+
IncorporationPartnershipLLCLLPProprietorshipGovernmentTechnician- Individual
yesno
HVAC/RSHEET METALPLUMBINGELECTRICAL
Rhode IslandMassachusettsConnecticutOther
Trade License # *
PRINCIPAL OWNERS, OFFICERS AND PARTNERS
Name:*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title:*
Email*
example@example.com
Drivers License:*
SS #:*
If multiple owners, please upload separate page at bottom of this form
PURCHASE DETAILS:
Purchase Order # Required for PurchaseJob Name showing on OrderPurchaser Name on OrderAdditional Instructions (Upload on separate page)
Pay Sales TaxTax ExemptTax Exempt Certificate (uploaded with this form)
Authorized Buyers for this Account: REQUIRED! including your name, list all people authorized to purchase under your account or upload separate page at bottom of form. *
If you have not identified authorized buyers, you are authorizing anyone to purchase under your account and will be held responsible for payment of all purchases.
Primary Contact :*
Primary Contact Telephone #:*
Accounts Payable Contact:*
Accounts Payable Telephone #:*
Accts Payable Contact Email:*
Email Addresses for Invoices:*
SIGNATURE AND CONSENT

We herein make application to Johnstone Supply for credit and/or to update and reconfirm our existing account and balance with Johnstone Supply. Johnstone Supply is authorized to contact any references or banks listed above and pull credit reports. If credit is granted, I (we) agree to pay for all goods purchased by the 10th of the month following date of invoice. In the event payment is not made and this account is referred for collection, we agree to pay cost of collection equal to a minimum amount of twenty-five percent of the principal amount. If suit or action by an attorney is instituted, we promise to pay reasonable attorney fees in said suit or action. Venue shall be in the state and county of Johnstone Supply’s choice. Applicant specifically understands that they are waiving their right in choice of venue. Applicant agrees to pay interest and service charges at the highest rate permitted by law. Applicant(s) give their permission to Johnstone Supply and/or its agents to verify and/or supplement the information listed hereon. I understand
that by providing the information above and signing this form, I am consenting to receive communications sent via facsimile and e-mail by, or on behalf of, Johnstone Supply.
Name*

First NameLast Name
File Upload-Required Information

Upload a picture of the EPA card representing your account and the trade license. This is required for all account requests.

If Tax Exempt, please upload tax exempt certificate

Account requests with incomplete information will not be processed.
Signature*

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File Upload

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INDIVIDUAL PERSONAL GUARANTEE
Must be completed by shareholders or owners with 10% or more interest.

Guarantor # 1 (All Information must be filled in as identified in field below)
Date

I,   First Name   Last Name , SS #   enter SS #   , residing at   Street Address   Address Line 2   City   State   Zip   ,for and in consideration of your extending credit at my request to   Company Name   (hereinafter referred to as the “Company”),
of which I am   Title   , hereby personally guarantee to you the payment at Johnstone Supply in the State of Rhode Island of any obligation of the Company or its successor and I hereby agree to bind myself to pay you on demand any sum, which may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.

Guarantor:First Name*   Last Name*   Guarantor Signature:   Signature

Witness :First Name   Last Name   Witness Signature:   Signature

Guarantor # 2
Date   Date

I,   First Name   Last Name   SS #   ss#   , residing at   Street Address   Address Line 2   City   State   Zip   , for and in consideration of your extending credit at my request to   Company Name   (hereinafter referred to as the “Company”),
of which I am Title   , hereby personally guarantee to you the payment at  Johnstone Supply in the State of Rhode Island of any obligation of the Company or its successor and I hereby agree to bind myself to pay you on demand any sum, which may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.

Guarantor:   First Name   Last Name   Guarantor Signature:  Signature

Witness:   First Name   Last Name   Witness Signature:   Signature
Should be Empty:

Application for Cash Account

Website Credential Requests:

BUSINESS INFORMATION

PRINCIPAL OWNERS, OFFICERS AND PARTNERS

PURCHASE DETAILS: