Credit Account Activation Form-Builder
Date
*
-
Month
-
Day
Year
Branch Location
*
Please Select
10 - New Construction
12 - Longview
21 - Greensboro
23 - Raleigh
24 - Charlotte
32 - Dallas
51 - Austin
53 - Houston
61 - San Antonio
Salesperson
Builder Information
Company Name:
*
Address
*
Street Address
Street Address Line 2
City
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Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Structure:
*
Corporation
Sole Proprietorship
Partnership
LLC
LP
Subdivision Name:
*
Number of Lots:
*
Number of Starts per Month:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Area Managers Name:
*
First Name
Last Name
Phone Number:
*
Email:
*
example@example.com
Construction Manager Name:
*
First Name
Last Name
Phone Number:
*
Email:
*
example@example.com
Billing Contact (A/P):
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Order and Billing Information
Purchase Order Required
*
Yes
No
Tax Status (**if tax exempt, a copy of the exemption is required)
*
Taxable
Exempt
Payment Method
*
ACH (preferred)
Check
Other
Email address for billing purposes
*
can list more than one
Does this project work off a draw:
*
Yes
No
What date are draws due:
Credit Line Desired: $
Bank Reference
Bank Name:
*
Account Number:
*
Contact:
*
First Name
Last Name
Bank Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Trade Reference
1. Company Name
*
Contact
*
Phone Number
*
Email
*
example@example.com
2. Company Name
Contact
Phone Number
Email
example@example.com
Upon the earlier of (a) the date indicated on this account activation form or (b) my (our) acceptance of services or goods from Impact Floors of Texas, LLC (Impact Floors), I hereby agree and represent as follows: (i) if I am delivering this account activation form on behalf of a company or other legal entity, I have the authority to bind such entity to the terms and conditions of this form, (ii) the information furnished on this form is true and correct in all respects, (iii) I (we) hereby deliver this form to Impact Floors, including, without limitation, for the purpose of obtaining a credit account with Impact Floors and Impact Floors may rely on all information set forth herein, (iv) I am (we are) authorized to bind the applicable owner(s) of the property or properties to which the goods and services contemplated hereunder relate, including with respect to any and all purchases or orders for goods or services made from Impact Floors related to such property or properties, (v) I (we) authorize any person having information related to the management company or the applicable owner(s) to release financial information as credit reports to Impact Floors.
Date
*
-
Month
-
Day
Year
Date
Title
*
Signature
*
Printed Name
*
I (we) further agree and acknowledge: (i) that all invoices shall be payable to Impact Floors at 2325 E. Belt Line Road Suite 200, Carrollton, Texas 75006, net 30 days of the invoice date, payable by check or ACH unless otherwise agreed in writing by Impact Floors, (ii) to pay interest at the lesser of (a) 18% per annum or (b) the maximum interest rate permitted by applicable law on all invoices not paid within 30 days of the invoice date, (iii) I (we) shall defend, indemnify, reimburse, and hold harmless Impact Floors from any and all losses, damages, fees, costs and expenses, including reasonable attorneys’ fees (including without limitation), fee costs and expenses related to collection of amounts outstanding or the enforcement of the terms hereof, including issuing demand letters and filing mechanics liens); (iv) performable in the terms of this account activation form or any matter arising hereunder or in connection with the goods and services contemplated hereby shall be Dallas County, Texas, (v) account activation will not be complete until I (we) have signed and delivered this account activation form, and (vi) I (we) have the authority to act as agent on behalf of the owner(s) of the property or properties to which the goods and services contemplated hereunder relate, including to bind such owner(s) to the terms and conditions hereof in all respects.
Date
*
-
Month
-
Day
Year
Date
Title
*
Signature
*
Printed Name
*
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