Business Account Form
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Business Account Information
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| Legal Business Name: ___________________________________________
Trade Name:___________________________________________________ Billing Address: _________________________________________________ City:_____________________________ State: ______ Zip Code: ___________ Shipping Address: ________________________________________________ City:_____________________________ State:______ Zip Code: ___________ Phone No. ___________________________________________ Business Is a: Corporation LLC Partnership Proprietorship Year Started: ______________ State of Business: _________ Federal I.D.#: ( FEIN )__________________________________ Web Site Address: ______________________________________ Sales Tax Exempt # (If Applicable) __________________________ Select Your Business Description: [ ] Building / Remodeling Contractor – Residential / Commercial [ ] Designer / Architect – Residential / Commercial [ ] Plumbing Contractor – Residential / Commercial [ ] Countertop Fabricator / Installer – Residential / Commercial [ ] Wholesale Distribution – Residential / Commercial [ ] Retail Sales – Residential / Commercial [ ] Showroom Retail Store [ ] Other Do you require a purchase order# ( PO’S ) before we accept an order? Yes No A/P Contact: ____________________________________________ A/P Email:__________________________ A/P Phone: __________________ Credit Card Information: VISA MASTERCARD DISCOVER AMEX One time Charge Only Save For Future Use Credit Card No: _____________________________________________ Name: ____________________________________________________ ( exactly how it appears on card ) Address: ___________________________________________ City: _______________________ State: ______ Zip: ______________ Home Phone: _______________________ Mobile # ______________________ Email: _________________________ Bank Reference: Bank Name: ___________________ Contact:___________________________ Address: _______________________ Phone No. __________________________ Type of Account: Checking No: ______________________________ Saving No: __________________________ Loan No: ____________________ Trade References: 1. Name: _____________________________ Contact:_________________ Address: _________________________________________________________ Phone No. _____________________ Account No. _______________________ 2. Name: _____________________________ Contact:_________________ Address: _________________________________________________________ Phone No. _____________________ Account No. _______________________ 3. Name: _____________________________ Contact:_________________ Address: _________________________________________________________ Phone No. _____________________ Account No. _______________________ You represent you are an authorized representative with authority to enter into this agreement and the information contained in this Application and any attachment is true, correct and complete. You consent to Vendor obtaining information about you personally and the Applicant from credit reporting agencies and other sources Vendor deems appropriate in considering this Application. If credit is extended, you agree to be bound by all of the terms and conditions on Vendor’s invoices and posted on Vendor’s website. All information on this application will be confidential, be held privately for company use only and not be disclosed to any sources other than Truebay. Signature _______________________________ Date ________________ Title ______________________________
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