Customer Service

your-company*

your-address*

address-details*

your-phone*

your-fax

ap-contact*

your-email*

company-website

your-company

your-address

address-details

your-phone

your-fax

ap-contact

your-email

your-company*

your-address*

address-details*

your-phone*

your-fax

ap-contact*

your-email*

Type a question

Do you have a showroom?*

YesNo

Are you a Member of Buying Group?*

YesNo

name*

Type a question

CorporationPartnershipSole Proprietorship

date-estabished*

incorporation-state*

fed-tax-id*

dun-bradstreet*

name*

title*

ss-no*

phone*

name*

bank-name

account-number

address

address-details

phone

your-fax

account-officer

your-email

company*

address*

address-details*

phone*

your-fax*

contact*

your-email*

company*

address*

address-details*

phone*

your-fax*

contact*

your-email*

company

address

address-details

phone

your-fax

contact

your-email

I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.

printed-name

title

credit-line

order-value

Terms and conditions: Credit terms are net 30 days from the date of invoice. All invoices not paid within 30 days of invoice date will be assessed 1.5% per month finance charges. Upon default, the entire balance shall be due and applicant agrees to pay the same as well as finance charges due. In the event this account is referred for collection after default, applicant agrees to pay all collection cost equal to minimum amount of 30% of the principle amount including but not limited to reasonable attorney fees. Houzer reserves the right to not extend credit to the applicant or to withdraw credit at any time at Houzer’s sole discretion. Personal Guarantee: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for any and all obligations set forth herein.

Please verify that you are human*

New Pro Customer Form

Bill to: (Invoice mailing address, if different from sold to)

Ship to:

Type of Business

Principal/Chief Officers

Credit Information

Bank Reference

Trade Reference