Apply

Application for New Account

Company Name(Required)

Address

City

State

Zip

Phone(Required)

Fax

Website

Purchasing Agent

Type of Business / SIC Code

Please Choose One

Corporation

Partnership

Proprietorship

Corporation ID #

Corporation Owner

Partnership ID #

Partnership Owner

Proprietorship ID #

Proprietorship Owner

D&B Number

Month & Year Established

Tax Exempt?

Yes (You will be asked to provide tax exempt certificate)

Bank Reference

Address

Phone

Fax

Bank Reference #1

Bank Reference Address #1

Bank Reference Phone #1

Bank Reference Fax #1

Bank Reference #2

Bank Reference Address #2

Bank Reference Phone #2

Bank Reference Fax #2

Bank Reference #3

Bank Reference Address #3

Bank Reference Phone #3

Bank Reference Fax #3

Trade Reference

Address

Phone

Fax

Trade Reference #1

Trade Reference Address #1

Trade Reference Phone #1

Trade Reference Fax #1

Trade Reference #2

Trade Reference Address #2

Trade Reference Phone #2

Trade Reference Fax #2

Trade Reference #3

Trade Reference Address #3

Trade Reference Phone #3

Trade Reference Fax #3

TERMS Net 30 Days
FINANCE CHARG: 1.5% on balance over 30 days
OVER 60 DAYS: placed on hold
OVER 90 DAYS: placed with a collection agency
ANY ACCOUNT SENT TO COLLECTION: will be liable for all fees, interest and legal costs

Name & Title

Signature

Date

ISO 9001 :2015 CERTIFIED

7P01F2-08-20-2020

Application for New Account

STAY UP TO DATE WITH TBI