Plumbing Supplies Email Credit Application

Email Credit Application

For a print out/fax version please click here

Phone:

Business Name:

Business is: Sole Proprietorship Partnership Corporation

Mailing Address:

Street: City: State: Zip:

Shipping Address:

Street: City: State: Zip:

Purchases will be resold: Yes No

Name of person to contact regarding accounts payable:

Phone Number (if different than above)

THE OWNERS, OR IF A CORPORATION, THE OFFICERS:
Owner: Name: Title: Street: City: State: Zip: Phone:	Owner (2): Name: Title: Street: City: State: Zip: Fax:

CREDIT REFERENCE (Please give full name, address and telephone number)
Reference 1: Name: Title: Street: City: State: Zip: Phone:	Reference 2: Name: Title: Street: City: State: Zip: Phone:	Reference 3: Name: Title: Street: City: State: Zip: Phone:

Quantities Needed: 1 1/2": 2": 3": 4": 3C: Available in few months 4C: Available in few months 3RS: Available in few months 4RS: Available in few months Nail:
Incentive Program: COMING SOON
How did you hear about us?	If Other: