Authorized Buyer / Contractor Form
ADD OR REMOVE AN AUTHORIZED BUYER / CONTRACTOR FOR USE OF YOUR CUSTOMER CREDIT ACCOUNT AT KIRCHNER BUILDING CENTERS
An authorized buyer is a person you grant permission to make purchases using your customer credit account at Kirchner Building Centers. By adding an authorized buyer, you are ultimately responsible for any charges made by that person / contractor.
Please specify if there is a specific duration of time this person / contractor is eligible to use your customer account.
Primary Account Holder Name
*
Email
*
example@example.com
Customer Code
*
Effective Date
*
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Month
-
Day
Year
Date
Account Action
*
Please Select
Add User
Remove User
Names of Persons / Contractors to Add or Remove to Authorized Buyer List on Account:
*
Please only add one name per line.
Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: