Bell Janitorial Supply Credit Application

Bell Janitorial Supply Credit Application
Business Information
Business Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
AP Contact Name
AP Email
example@example.com
AP Phone
Please enter a valid phone number.Format: (000) 000-0000.
AP Fax
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business
Federal Tax ID Number
Are you sales tax exempt?
Sales Tax Number
Date Established

MonthDayYear
Date
Number of Employees
Owners/Officers
Please list the business owners or officers authorized to apply for credit. Click 'Add More' to enter multiple entries.
Please select how you would like to set up your account:

This helps us gather the correct information based on your account type.
How would you like to set up your account?
Trade References

Please provide at least two suppliers/vendors your business has previously worked with.
Reference #1 - Company Name
Company Name
Reference #1 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1 - Address
Reference #1 - Fax Number
Reference #2 - Company Name
Company Name
Reference #2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 - Address
Reference #2 - Fax Number
Bank Reference

Please provide the contact information for the bank your business currently uses.
Bank Name:
Bank Contact Name
Bank Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Bank Address
Account #
This is for internal use only and kept strictly confidential.
Terms of Payment
I/We hereby authorize Bell Janitorial Supply or its representatives to obtain a credit report and agree to the release of credit information. This authorization shall remain valid without expiration, and a photocopy or fax copy shall be given the same effect as the original.

Unless otherwise agreed in writing, the applicant agrees to pay any amount due within 30 days from the invoice date via cash, check, money order, or cashier’s check. Other payment forms may incur a service fee.

In the event of late payment, a 2% monthly service charge (24% annually) will be applied to unpaid balances.

If legal action is necessary to collect payment, the applicant agrees to pay reasonable attorney fees and court costs. If the account is referred to a collection agency or attorney, the applicant also agrees to pay an additional amount equal to 50% of the principal balance, reflecting costs of collection processing.
Required
Authorized Signature

Please sign below to confirm the accuracy of the information provided and your agreement to the terms above.
Authorized Company Signature
Printed Name
Title or Role
Date Signed

MonthDayYear
Date
Should be Empty:

Bell Janitorial Supply Credit Application

Business Information

Owners/Officers

Please select how you would like to set up your account:

Trade References

Bank Reference

Terms of Payment

Authorized Signature