75+ Years
YEARS IN BUSINESS
Women-owned
CERTIFIED SINCE 1999
74+ Years
(to be accompanied with credit application)
Date: *
Credit Line Request: *
Customer Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Fax:
Invoice Submission Preference: *
Terms: Terms Enter terms details:
Credit Card: Completed and signed credit card form attached Credit Card Form:
Order Promise Date:
Special Instructions:
Vendor Rebates that should be applied:
CASH (Counter Sales)DPO (Delivery Purposes Only)EXP (Export)CONS (Consignment)CMMSMRO (Maintenance, Repair & Operations)REIM (Reimbursable Pass Thru)PROJ (Projects: Non-CMMS)CC (Credit Card)W (CMMS Work Order)
AERP (Aerospace Contractors)CASH (Counter Sales)COMC (Commercial Contractor)COMP (Competitors)DATA (Datacom)EC (Engineering & Construction)EP (Exploration & Production)FOOD (Food Production)HVAC (HVAC)NDC (Industrial Contractor)LSD (Lost, Stolen, Damaged)
MISC (Miscellaneous)MROI (Industrial MRO)MUNI (School, Hospital, Municipal)OEM (Fab & Manufacturing)PM (Paper Mills)PROP (Property Management)PT (Pipeline & Transportation)RETL (Retail)SMBS (Small Business)UTIL (Utility)
Signed Credit Application submitted online Yes
Customer PO Reference Sheet YesNo
Existing Customer Account # Tax Document ResaleExempt
Other
Signature (please sign if able from your device AND type your name).
I agree and understand that my typed-in name will be equivalent to my handwritten signature.(field is required)
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