Chandler's Credit Application

COMPANY INFORMATION
Name of Company / Firm *
Parent Company (If Subsidiary)*
Business Location Address *
Street, City, Zip
Mailing Address*
Street, City, Zip
Business Phone Number*
Please enter a valid phone number.
Business Fax Number
Please enter a valid phone number.
Proprietors’ or Partners’ Names
Officers 1
Officers 1 Phone Number
Please enter a valid phone number.
Officers 2
Officers 2 Phone Number
Please enter a valid phone number.
Type of Business *
Insured By
Contractor License #
Resale Permit #
Date Business Started
BANK ACCOUNT INFORMATION
Name of Bank*
Bank Phone Number*
Please enter a valid phone number.
Bank Fax Number
Please enter a valid phone number.
Bank Account Number*
Email
example@example.com
TRADE REFERENCES: MATERIAL SUPPLIERS, DUMP SITES, ETC.
Trade Reference Name*
Trade Reference Address*
Trade Reference Phone Number*
Please enter a valid phone number.
Trade Reference Fax Number
Please enter a valid phone number.
Trade Reference Account #*
Trade Reference Email*
example@example.com
Trade Reference Name
Trade Reference Address
Trade Reference Phone Number
Please enter a valid phone number.
Trade Reference Fax Number
Please enter a valid phone number.
Trade Reference Account #
Trade Reference Email
example@example.com
Trade Reference Name
Trade Reference Address
Trade Reference Phone Number
Please enter a valid phone number.
Trade Reference Fax Number
Please enter a valid phone number.
Trade Reference Account #
Trade Reference Email
example@example.com
Are you bidding a job?*

YesNo
Is this for a specific job?*

YesNo
What dump sites have you used previously?*
Will you be picking up material?*

YesNo
Where do you normally buy material?*
What kind of material and how much?*
Do you use P.O. numbers?*

YesNo
Do you use job numbers?*

YesNo
*Please note: We will only invoice by P.O. or job numbers.
*** THERE IS A MINIMUM OF 10 WORKING DAYS REQUIRED TO SET UP A NEW ACCOUNT ***
**** APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED ****
Our terms are net 30 days. Past due accounts will be placed “on hold,” and such accounts will be “stopped at the scales.” It is your responsibility to keep your account current. By submitting this application you authorize CHANDLER’S to make inquiries to the business and/or trade references you have supplied. The execution of this application constitutes a representation that it is signed by a person authorized to do so on behalf of the applicant, and that applicant has the ability to pay and will pay all invoices in accordance with our terms. In the event that we have to retain an attorney to collect any amount due to CHANDLER’S from the applicant, the applicant agrees to pay reasonable attorney fees.
This application must be complete with a signature
Name and Title*
Today's date*

MonthDayYear
Email*
example@example.com
Customer signature*

Clear
Please verify that you are human*
Should be Empty:

COMPANY INFORMATION

BANK ACCOUNT INFORMATION

TRADE REFERENCES: MATERIAL SUPPLIERS, DUMP SITES, ETC.