APPLICATION FOR CREDIT

APPLICATION FOR CREDIT

and agreement with Dolan's
THIS DOCUMENT IS ENCRYPTED FOR YOUR SECURITY
Applicant / Business Name:
Proprietorship:

CorporationPartnershipLLC
Dolan's Sales Representative:
Tax ID Number:
Business Address:
How long at current address?
Resale Permit:
Taxable:

YesNo
Office Phone:
Please enter a valid phone number (10 digits)
Mobile Phone:
Please enter a valid phone number (10 digits)
Check this box to opt out of text messages
Fax:
Please enter a valid fax number (10 digits)
E-mail:
example@example.com
PRINCIPALS, ADDRESSES AND HOME PHONE
Contact Information

(List 3 Names)
Name 1:
Title:
Address:
Phone Number:
Please enter a valid phone number (10 digits)
Email:
example@example.com
Name 2:
Title:
Address:
Phone Number:
Please enter a valid phone number (10 digits)
Email:
example@example.com
Name 3:
Title:
Address:
Phone Number:
Please enter a valid phone number (10 digits)
Email:
example@example.com
Has the applicant or any of listed principals filed any form of bankruptcy in the last seven years?

YesNo
Contractor's License:
Expiration Date:
Years in Business?
Credit Amount Requested?
BANK / INSTITUTION REFERENCES
Bank / Institution Name:
Address:
Contact Name:
Phone:
Please enter a valid phone number (10 digits)
Email:
example@example.com
Type of Account:

CheckingSavingsOther
BUSINESS/TRADE REFERENCES
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name:

First NameLast Name
Email:
example@example.com
Phone:
Please enter a valid phone number (10 digits)
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name:

First NameLast Name
Email:
example@example.com
Phone:
Please enter a valid phone number (10 digits)
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name:

First NameLast Name
Email:
example@example.com
Phone:
Please enter a valid phone number (10 digits)
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name:

First NameLast Name
Email:
example@example.com
Phone:
Please enter a valid phone number (10 digits)
LIST AUTHORIZED BUYERS ON YOUR ACCOUNT
Name 1:
License Number:
Name 2:
License Number:
Name 3:
License Number:
Name 4:
License Number:
TO EXPEDITE ORDERS, INDICATE PREFERENCES BELOW

Please Check "Yes" or "No" on the Following
P.O. number on every quote & order?

YesNo
Job name on every quote & order?

YesNo
Authorized buyer on every quote & order?

YesNo
Receive invoices by email in addition to being mailed to your billing address?

YesNo
TERMS OF PURCHASE
Net 10^th. Account becomes past due on the 25^th of the month following date of purchase. A service charge of 1.5% per month will be charged on all past due amounts. The undersigned agrees to pay all costs, including reasonable attorney fees incurred for collection. Title passes to the purchaser upon delivery to the carrier of any material shipped for your account.

Returned goods must be accompanied by purchased receipt and will be subject to inspection and restocking charges. The undersigned cerifies the above information to be true and correct. This form is submitted for the purpose of obtaining credit and Dolan’s is authorized to investigate your credit. I/We agree to the above terms and conditions of sale. This agreement shall be regarded as continuous until another is substituted for it.

I/We personally guarantee payment of any and all obligations of the applicant to Dolan’s and agree to be bound by the above terms and conditions.
This box must be checked to process your application.*

YES. I have read the Terms of Service.
Authorized Signature Required:

Clear
Date:

MonthDayYear
Name: (Please print)
Title:
Please verify that you are human*
If you have questions, please call us. We will be happy to help you.

Phone (925) 926-1030
Should be Empty:

APPLICATION FOR CREDIT

PRINCIPALS, ADDRESSES AND HOME PHONE

Contact Information

BANK / INSTITUTION REFERENCES

BUSINESS/TRADE REFERENCES

LIST AUTHORIZED BUYERS ON YOUR ACCOUNT

TO EXPEDITE ORDERS, INDICATE PREFERENCES BELOW

TERMS OF PURCHASE