Customer Information Form
Business Name
*
What would you like to accomplish today?
*
Apply for terms
Increase terms
Update company information
Open New Account
Company Information
Please only complete the lines that need updating.
Phone Number
*
-
Area Code
Phone Number
Billing Email
*
example@example.com
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Resale Certificate Number
*
Tax ID Number
*
Ownership
*
Corporation
Partnership
Sole Proprietor
LLC
Principal
Person responsible for business transactions
*
First Name
Last Name
Position
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
Account Terms
Applying for
*
CBD Cash Before Delivery
COD Company Check
Open Account Terms
Account limit requested
*
In US dollars
Trade References
First Trade Reference
Company Name
Company Contact
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Account Number
Email
example@example.com
Second Trade Reference
Company Name
Company Contact
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Account Number
Email
example@example.com
Bank Reference
Institution Name
Account Number
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization
Authorization
The above-named firm hereby agrees to be bound by, and acknowledges receipt of, San Benito Shutter's Standard Terms and Conditions of Sale, which are set forth in all product price lists and/or order forms. I agree that I am fully authorized by the above named firm to sign this agreement on its behalf. I authorize San Benito Shutter to conduct investigations as San Benito Shutter sees fit including: contacting the above trade references and banks as well as obtaining reports. I authorize all trade references, banks and credit reporting agencies to disclose to San Benito Shutter any and all information pertaining to the financial history of the company and myself. I have read the terms and conditions stated above and agree to all those terms and conditions.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Signature
*
Personal Guarantee
I/we sign this personal guarantee for the benefit of my/our company. In the event of default, I/we agree to be personally responsible for any unpaid balances owed to San Benito Shutter. I/we furthermore agree to pay all fees incurred by San Benito Shutter in collection of any past due balances. Additionally, I/we agree to pay the maximum storage charge and interest allowed by law on such past due balances. I/we hereby waive any rights I/we may have, under civil code section 2845 or otherwise, to require San Benito Shutter to proceed against the above named firm or to pursue any other remedy before enforcing this guarantee.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: