“OPEN ACCOUNT” Billing is a convenient method of payment for regular, recurring purchases.  Open Account is a privilege extended to regular customers whose financial ability is established.  It should not be confused with“Term Payment” or “Buying on Credit” which is a function of money lending institutions.

Please scroll down, print and fill out page two of this web page

APPLICATION FOR OPEN ACCOUNT BILLING

Name:                                                                                                                         Phone:                             

Billing Address:                                                                                                          Fax:                                

City:                                                                                                                State:            Zip:                         

Shipping Address:                                                                                                                                             

City:                                                                                                                State:            Zip:                         

Nature of Business:                                                                                         Years in Business:                  

Ownership:     Individual Partnership:              Corporation:             Fed ID/SSN#:                                    

Principal Owners/Officers/Titles:                                                                                                                   

Bank and Location:                                                                                                                                              

Bank Phone Number:                                                                  Account Number:                                          

BUSINESS REFERENCES

Name:                                                                                       Phone:                           Fax:                           

Address:                                                                                                                                                           

Name:                                                                                       Phone:                           Fax:                           

Address:                                                                                                                                                           

Name:                                                                                       Phone:                           Fax:                           

Address:                                                                                                                                                           

SPECIAL BILLING INSTRUCTIONS

Number of invoices required:                          Are purchase order numbers required:              

Are your purchases subject to sales or use tax? Yes      No      (If no please send current tax-exempt form)

TERMS          NET 15th

*Delinquent accounts are subject to 1 and 1/2 % per month interest charges of delinquent balance.*

"OPEN ACCOUNT" billing is a convenient method of payment for regular, recurring purchases. Open Account is a privilege extended to regular customers whose financial ability is established.  It should not be confused with "Term Payment" or " Buying on Credit" which is a function of money lending institutions.

Signed:                                                                                          Date: