Application for Commercial Credit

Legal Company Name*
DBA/Div.
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is the billing address the same as the shipping address?*
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Main Business Phone*
Main Business Fax #
In Business Since*
Number of Employees*
Business Type*
If other, please fill in.*
Federal ID # or SS#*
Tax Exempt #
Please attach a copy of your sales tax exempt certificate or taxes could be charged to your purchases.

Business References
Bank Name*
Account Number
Bank Phone Number*
Bank Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Trade Name*
Trade Phone Number*
Trade Fax Number*
Trade Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Trade Name*
Trade Phone Number*
Trade Fax Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Trade Name*
Trade Phone Number*
Trade Fax Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Customer Acknowledgment of Selling Terms and Conditions
If this application is accepted by Birmingham Fastener, Inc. (its affiliates and/or subsidiaries) (BFI), then Applicant agrees to the BFI Terms & Conditions of Sale, found at www.bhamfast.com/terms. Without limiting the forgoing, Applicant agrees that payment is due N-30 days from invoice date. A late charge of 1 ½ % per month is assessed to an account past due; and, Applicant in the event of default and that legal action or an outside service shall become necessary to effect collection for the merchandise, product or service purchased from BFI, Applicant agrees to pay all cost of collection, including reasonable attorney fees, interest and all court cost incurred. Applicant authorizes BFI to obtain a written or oral credit report from any credit reporting agency, bank or commercial business with whom the applicant is or has done business, and, agrees to assist BFI in the credit investigation and any re-investigation.
Signed*
Title*
Date*
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Business References