CREDIT APPLICATION
Tully Building Supply & Alpine Building Supply
Phone: 315-696-8984 - Fax: 315-696-6119
Phone: 315-497-1221 - Fax: 315-497-3827
Company Name__________________________________________
Address ________________________________________________
Form of Business _________________________________________
Tax exempt number (if applicable)_____________________________
Please Check one of the following and provide the applicable tax identification number.
__ Sole Proprietor ________________________________________
__ Partnership ___________________________________________
__ Corporation ___________________________________________
Names of Principal Owners or Officers:
1. _______________________________, Title _________________
2. _______________________________, Title _________________
3. _______________________________, Title _________________
Personal Information:
Street Address _________________________________________
Phone # _______________________ Date Of Birth ____________
Fax # __________________ E-mail Address _________________
Social Security # ________________________________________
Credit References: Name
1. __________________________________
Telephone and/ or fax numbers ______________________________
2. __________________________________
Telephone and/ or fax numbers ______________________________
Please provide us with the names of people who are authorized to charge on your account:
Please read the following carefully and sign below. A signature is required to process this application:
We understand that all the above information is correct and that we fully understand your credit terms to be, net 30 days at the rate of 1 1/2% a month. In the event of default in payment and referral of delinquent account for collection,. the customer will be responsible for payment of reasonable attorney's fees, costs, and disbursements allowed.
Signed:_____________________________________ Date:______
