Take Action

Please complete the form below prior to scheduling any projects you plan to charge. Payment will be due at the time of service for customers without an approved account.

Name

First Name

Last Name

Business Name

Type of Business

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Additional Phone

(###)

###

####

Fax

(###)

###

####

Accounts Payable Contact/Phone #

Owner/President Name/Phone

Partner or Officer/Name/Phone

Bank Name/City, State/Phone

Bank Name/ City, State/Phone

Trade Reference #1/ Name/ City, State/Phone/Fax

Trade Reference #2/ Name/ City, State/Phone/Fax

Trade Reference #3/ Name/ City, State/Phone/Fax

I Agree

I understand that should credit be extended, payment in full is due 30 days from the date of the invoice. Any amount unpaid after thirty days from the date the debt is incurred is subject to a late payment charge of 1.5%. Accounts with balances over 60 days will be placed on a cash only basis until the past due balance in cleared. I agree to notify you of any material changes on the statements made in this application and authorize you to obtain any information you require concerning the statements made herein. I Hereby certify that all statements made herein are correct. I agree to pay all costs, including reasonable attorney fees, incurred by you for collection of this account. I understand that the fact that a late payment charge will be imposed does not authorize payments to be made in installments or in any other manner than herein provided except that I may pay the account in full at any time.

Yes