NEW ACCOUNT SIGN UP

NEW ACCOUNT SIGN UP FORM

                                                 

NAME:___________________________________BILLING ADDRESS:_____________________


PHYSICAL ADDRESS:_____________________________PHONE # _________________________

CITY:______________________________________STATE:___________ZIP CODE:_____________


TYPE OF ORGANIZATION:    CORP______PARTNERSHIP______INDIVIDUAL______


IF CORPORATION, DATE & STATE OF INCORPORATION:  DATE:______________STATE:______

EST. MONTHLY PURCHASES_________________      _PURCHASE ORDERS REQUIRED________


REFERENCES:

BANK:______________________________________ADDRESS:__________________________________

BANK OFFICER:_____________________  ACCOUNT #:__________________ PHONE #___________

COMMERCIAL & INDUSTRIAL SUPPLIERS    ADDRESS       PHONE & FAX

      1.____________________________________________________________________________

      2.____________________________________________________________________________

      3.____________________________________________________________________________

      4._____________________________________________________________________________



NAME, ADDRESS, AND PHONE # OF OWNERS

_________________________________________________________________________________________


SIGNATURE___________________________________TITLE____________________DATE_________




This application is for a “CASH-ON-DELIVERY” account only.  All invoices must be paid upon delivery of merchandise. Only cash, certified funds, or credit card payments will be accepted. WE DO NOT ACCEPT CHECKS. No credit for merchandise will be allowed.


The statement mailed to you each month will reflect charges and credits for the month to your account, through the last calendar day of each month, due by the 15th of the month following the date od the statement, payable in Fort Worth, Tarrant County, Texas. We reserve the right to charge interest at the highest legal rate on charges not paid within 30 days of the due date. Bumper Manufacturing’s acceptance of this application is conditioned upon my entry into Security Agreement. The Security Agreement is incorporated into this application and becomes part of my agreement with Bumper Manufacturing.   

NEW ACCOUNT SIGN UP FORM

                                                 

NAME:___________________________________BILLING ADDRESS:_____________________


PHYSICAL ADDRESS:_____________________________PHONE # _________________________

CITY:______________________________________STATE:___________ZIP CODE:_____________


TYPE OF ORGANIZATION:    CORP______PARTNERSHIP______INDIVIDUAL______


IF CORPORATION, DATE & STATE OF INCORPORATION:  DATE:______________STATE:______

EST. MONTHLY PURCHASES_________________      _PURCHASE ORDERS REQUIRED________


REFERENCES:

BANK:______________________________________ADDRESS:__________________________________

BANK OFFICER:_____________________  ACCOUNT #:__________________ PHONE #___________

COMMERCIAL & INDUSTRIAL SUPPLIERS    ADDRESS       PHONE & FAX

      1.____________________________________________________________________________

      2.____________________________________________________________________________

      3.____________________________________________________________________________

      4._____________________________________________________________________________



NAME, ADDRESS, AND PHONE # OF OWNERS

_________________________________________________________________________________________


SIGNATURE___________________________________TITLE____________________DATE_________




This application is for a “CASH-ON-DELIVERY” account only.  All invoices must be paid upon delivery of merchandise. Only cash, certified funds, or credit card payments will be accepted. WE DO NOT ACCEPT CHECKS. No credit for merchandise will be allowed.


The statement mailed to you each month will reflect charges and credits for the month to your account, through the last calendar day of each month, due by the 15th of the month following the date od the statement, payable in Fort Worth, Tarrant County, Texas. We reserve the right to charge interest at the highest legal rate on charges not paid within 30 days of the due date. Bumper Manufacturing’s acceptance of this application is conditioned upon my entry into Security Agreement. The Security Agreement is incorporated into this application and becomes part of my agreement with Bumper Manufacturing.   













NEW ACCOUNT SIGN UP

NEW ACCOUNT SIGN UP FORM



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