CUSTOMER INFORMATION

CUSTOMER INFORMATION
Fill in all spaces and complete by signing where indicated. A signature is required prior to receiving credit terms. If it is a corporation, the signature must be that of an officer, stating title. Incomplete applications cannot be processed.
Company Name
DBA (if applicable)
Year Established
Type of Company
Federal Tax ID#
Company Address

Street Address

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Email Address for Order Confirmation
example@example.com
A/P Email Adress
example@example.com
Billing Address (If different)

Street Address

CityState

Zip Code
Principals, Officers or Owners
Name
Title
Name
Title
Residents Address (If different)

Street Address

CityState

Zip Code
Mobile Phone Number
Please enter a valid phone number.
Authorized Signature

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Date

MonthDayYear
Date
TRADE REFERENCE

[References are not required for Proforma customers.]

Institution Name
Checking Account #
Address
A/P email address
example@example.com
Phone Number
Please enter a valid phone number.
Desired Terms
Credit Limit
I/we agree that payments will be made in accordance with the terms stated. I/we understand all invoices are payable on the date of the invoice unless other terms are granted by Elite Decor Inc. and that a service charge of 1.5% per month will be added to all past due balances. In the event that payment is not made and my/our account is referred for collections, I/we will pay all costs of collections. If legal action is required. I/we will pay reasonable attorney's fees and court costs resulting from such action.
Authorized Signature

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Date

MonthDayYear
Date
Should be Empty:

TRADE REFERENCE