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CONTRACTORS DEPOT |
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48 Island Drive, Eastpoint, FL 32328 Tel (850) 670 1100 Fax # (850) 670 1122 |
OPEN ACCOUNT APPLICATION
All information
contained in this application will remain confidential.
Date:_______________
Tax I.D. No._____________________
Company Name:______________________________
D/B/A_________________________
Mailing Address:______________________________________________________________
Billing
Address: ______________________________________________________________
Telephone:___________________________
Fax:______________________________
Type of Business:___________________________
Date Started:______________
Check
one Sole proprietorship____ Partnership____ Corporation____ State____
Name of Senior Executive of the Company_________________________
Is you business Tax Exempt? ___
If yes please attach a copy of your resale certificate and
provide us with a blanket certificate of resale.
Bank References
(Please do not list infrequent accounts)
Main Bank:_________________________________
Phone:___________________
Address:__________________________________________
Fax:_____________________
Account #(s)___________________________
Name of Bank Officer___________________
Trade References
Trade Reference 1: Company_________________________
Phone:___________________
Address:_________________________________________
Fax:_____________________
Trade
Reference 2: Company_________________________
Phone:___________________
Address:_________________________________________
Fax:_____________________
Trade Reference 3: Company:________________________
Phone:___________________
Address:_________________________________________
Fax:_____________________
The undersigned on behalf of the Applicant, authorizes Contractors Depot to obtain
such information as it may require from the above bank and trade references
which have been furnished by the Applicant for the purpose of obtaining credit.
A fax or photocopy of this form will be deemed as acceptable
authorization for the releaser of any necessary credit information.
The undersigned certifies that this application has been accurately completed and represents current data.
This application is made with the understanding and agreement that all charges will
be due and payable by the 10th day of the month following charges,
unless other terms are stated thereon, and that a monthly service charge of 1.5%
will be paid on all balances which are past due.
In the event the account becomes delinquent, the undersigned agrees to
pay all attorneys fees and cost extended
to effect collection of the account.
Name_____________ Signature____________ Title____________