APPLICATION FOR CREDIT TERMS COMPANY Company Name: * Company Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Accounts Payable Email: * OWNERSHIP Name * First Name Last Name Type of Ownership (Select One): * Corporation Partnership Sole Proprietorship Tax Exempt Send resale certificate to 'administrator@chicagobrass.com' Yes NO FINANCIAL Bank Name: * Bank Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact * Contact Email: * Phone: * (###) ### #### REFERENCE #1: Business Name / Contact * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email Doing Business Since: REFERENCE #2: Business Name / Contact * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Doing Business Since: REFERENCE #3: Business Name / Contact: * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email Doing Business Since: AUTHORIZATION Purchase Orders required for prompt payment: Yes No Authorized to Charge: USE OF CREDIT TERMS • All credit card payments have an associated 3.5% fee. • Deposits will be invoiced against charge accounts at time of order conversion. • Typical terms are net 30. Any deviations must be agreed to in writing prior to order placement. • Terms are extended to the company listed above, not their clients or specific projects. It is the responsibility of the agreeing party to provide timely payment. • Deposits will be required on custom manufactured and extraordinary projects at the sole discretion of Chicago Brass, Inc. • Chicago Brass, Inc. reserves the rights to revoke credit terms at any point without notice. • Account establishment may take up to 4 weeks to process. • By signing below, all points are agreed upon and information filled out is correct. NOTES SIGNATURE I Acknowledge That I Have Read And Understand The Use of Credit Terms As Detailed Above. * Name * First Name Last Name Date * MM DD YYYY Position * Thank you!
