OPENING AN ACCOUNT IS EASY. SIMPLY FILL OUT THE NEW-ACCOUNT FORM BELOW, (you may copy and paste to other formats, or print out a hard-copy) AND SEND IT BACK TO US BY EMAIL, FAX OR SNAIL-MAIL ALONG WITH ANY REQUIRED DOCUMENTATION INDICATED BELOW. ONCE YOUR ACCOUNT IS ESTABLISHED YOU MAY ORDER FROM US ANY TIME VIA PHONE, EMAIL OR FAX.
Open an Account
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Safety & Occupational Supply Enterprises
*Please send a W-9 form and tax exempt certificate (if applicable) with all completed credit applications*
Business Credit Application:
Last: First: Title
Name of Business:
Tax I.D. Number
Address:
City: State: ZIP:
Phone:
Company Information
Type of Business:
In Business Since:
Legal Form Under Which Business Operates:
Corporation ð Partnership ð Proprietorship ð LLC ð Other ð
If Division/Subsidiary, Name of Parent Company: In Business Since:
Name of Company Principal Responsible for Business Transactions: Title:
Address: City: State: ZIP:
Phone:
Accounts Payable Contact Information: Phone:
Email: Fax:
Shipping and Billing Address:
Billing Address:
Shipping Address (if same as billing) check here: ð
City, State, Zipcode:
Teephone #: Fax#:
Additional Shipping Instructions/Comments:
Bank References:
Institution Name:
Payment Terms:
Please select the payment options you would prefer:
ð Net Terms (Please note our terms are 1%10 Net 30 Days).
ð EFT (For EFT Please Include Bank Name, Routing Number & Account Number)
ð Credit Card; Please Provide Credit Card Type, Number,
Expiration Date and Security Number:
Tax Information: Sales tax will be added to all invoices unless exempt form is completed and exempt certificate is attached. Is customer a Reseller?
Please circle *Yes No
*If yes, please provide Resale Certificate for each applicable state.
(Seller’s Permit does not meet requirement for deferring sales tax).
Is Customer Tax Exempt? Please circle *Yes No *
If yes provide Tax Exempt Document
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify information contained herein.
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Signature Date
______________________________________ ______________________________________
Printed Name and Title Date
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