Commercial Credit Application

BUSINESS INFORMATION

FULL BUSINESS NAME*

PHONE NUMBER*

Area CodePhone Number

BUSINESS MAILING ADDRESS*

Address

FAX NUMBER

Area CodeFax Number

City

EMAIL

example@example.com

State

HOW LONG IN BUSINESS?

Zip Code

Sole ProprietorshipPartnershipCorporation

PRINCIPAL STOCKHOLDER OR OWNER

NAME*

First NameLast Name

TITLE*

PHONE NUMBER*

Area CodePhone Number

SSN*

PERSON RESPONSIBLE FOR PAYING INVOICES

NAME*

First NameLast Name

TITLE*

PHONE NUMBER*

Area CodePhone Number

SSN*

EmailFaxMail

ACCOUNTS PAYABLE

FAX NUMBER

Area CodeFax Number

EMAIL

example@example.com

BANKING INFORMATION

BANK NAME*

CITY/ADDRESS*

PHONE NUMBER*

Area CodePhone Number

OFFICER

PLEASE PROVIDE THREE TRADE REFERENCES

COMPANY NAME

CITY/STATE

PHONE NUMBER

Area CodePhone Number

FAX NUMBER

Area CodeFax Number

COMPANY NAME

CITY/STATE

PHONE NUMBER

Area CodePhone Number

FAX NUMBER

Area CodeFax Number

COMPANY NAME

CITY/STATE

PHONE NUMBER

Area CodePhone Number

FAX NUMBER

Area CodeFax Number

ESTIMATED ANNUAL SALES

ESTIMATED MONTHLY PURCHASES

YEAR-END FINANCIAL STATEMENT/INTERIM STATEMENTS

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AGREEMENT

A finance charge of 2% per month, 24 per annual, or as otherwise provided by the laws of your state. As consideration of the extension of credit, the undersigned understands and agrees that the failure to send written notice of contesting any invoices within 5 days of the invoice date, shall constitute an acceptance of the invoices and the undersigned waives any and all decreases to the amount contained therein.

NAME*

TITLE*

DATE*

SIGNATURE*

PERSONAL GURANTEE

To induce Plumbers Wholesale Supply & Atlas Plumbing Supply to sell goods on credit to the above company, the undersigned personally guarantees and agrees to pay when due, or upon demand, the full amount of any indebtedness owing to Plumbers Wholesale Supply Company & Atlas Plumbing Supply in connection with such sales on credit plus reasonable attorney fees and collection cost.

NAME*

TITLE*

DRIVERS LICENSE #*

SIGNATURE*

PHOTO OF DRIVERS LICENSE*

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DATE*