Credit Application

WELCOME! LET'S GET STARTED AND GET YOU APPROVED.

Please complete all the required fields on the following form and we will begin the credit review process.

CREDIT POLICY

We offer credit accounts of Net 30 days from the date of the invoice. Accounts with no activity over a 24-month period may be subject to an updated credit review before terms can be re-established.

We will keep you informed of the status of your account with invoices, statements, emails, and telephone calls as needed. Please inform us immediately if there is a product problem, invoice problem, or other reason for lack of payment.

If you need further information or have any questions, please feel free to contact our Accounting department at (800) 333-0650.

CURRENT H&R CONTACT
Are you currently working with a Parts Specialist?*

YesNo
Please Choose Your Parts Specialist:
YOUR INFORMATION
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

BILL TO INFORMATION
Exact Name*
Division of Subsidiary
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com

SHIP TO INFORMATION

If different than bill to information
Exact Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.

GENERAL BUSINESS INFORMATION
Type Of Business*
Years in Business*
Year Incorporated*
State/Province Incorporated*
D.B.A.
Individual

First NameLast Name
Partnership
Corporation
Are you sales and/or use tax exempt?*

YesNo
If yes, please attach your certificates

Cancelof
Are Purchase Orders Required?*

YesNo
ACCOUNTS PAYABLE CONTACT
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

BANK REFERENCE
Bank Name*
Officer Handling

First NameLast Name
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Checking Account Number*
Savings Account Number*
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com

TRADE REFERENCES

Minimum of three references required. Oil or utility companies are not allowed.
Company Name
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Company Name
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Company Name
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com

TERMS AND CONDITIONS

You (the undersigned) understand and agree that you are responsible for remitting payments to H&R Construction Parts and Equipment, Inc. (H&R) for products ordered by you or by all buyers on your behalf. Payment for services H&R provides to you must be made by the due date, 30 days from the invoice date. For consideration, any and all complaints on goods or services delivered must be made, in writing within 30 days of the invoice date.

You agree to reimburse H&R for any costs incurred in attempting to collect past due amounts, including but not limited to the fees and expenses of attorneys, court costs, and collection agencies. Should any payment processed be returned unpaid, you will pay a $35.00 charge plus bank fees incurred.

AUTHORIZATION TO OBTAIN CREDIT REPORT/HISTORY

H&R is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein to determine your creditworthiness.

You hereby agree that any disputes arising out of this agreement of goods and services ordered or delivered pursuant hereto will be governed and settled under the applicable principles of New York State Law, under the jurisdiction of New York State Courts and that any venue in any such action shall be in the County of Erie.

ACKNOWLEDGEMENT

Furthermore, by signing this application, you acknowledge that you have read and understood the terms and conditions and agree to abide by them accordingly.

You warrant that you have the authority to execute this Open Account Agreement and further certify the request is for the extension of credit for business purposes.
Signature*

Clear
Name*

First NameLast Name
Title*
Date*

MonthDayYear
NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Consumer Financial Protection Bureau, P.O. Box 4503, Iowa City, Iowa 52244.
Please verify that you are human*
Should be Empty:

CURRENT H&R CONTACT

YOUR INFORMATION

BILL TO INFORMATION

SHIP TO INFORMATION

GENERAL BUSINESS INFORMATION

ACCOUNTS PAYABLE CONTACT

BANK REFERENCE

TRADE REFERENCES