Specializing in all Professional Construction Supplies & Fasteners Since 1981
732-747-1323
UPTITE FASTENERS CREDIT APPLICATION
Business Name
Bill to Address (Street or Box Number)
Telephone Number
Fax Number
(City)
(State)
(County)
(Zip Code)
Ship to Address (Street Number)
(City)
(State)
(County)
(Zip Code)
Telephone Number
Fax Number
Ownership:
Principals:
(Name)
(Title)
Home Address (Street Number)
(City)
(State)
(County)
(Zip Code)
(Name)
(Title)
Home Address (Street Number)
(City)
(State)
(County)
(Zip Code)
(Name)
(Title)
Home Address (Street Number)
(City)
(State)
(County)
(Zip Code)
Length of Time in Business
(Years)
(Months)
Type of Business:
Tax Exemption if Applicable:
(Name)
Bank Reference
(Street Number)
(City)
(State)
(Zip Code)
(Telephone #)
(Name)
Trade Reference
(Street Number)
(City)
(State)
(Zip Code)
(Telephone #)
(Name)
Trade Reference
(Street Number)
(City)
(State)
(Zip Code)
(Telephone #)
(Name)
Trade Reference
(Street Number)
(City)
(State)
(Zip Code)
(Telephone #)
Applicant authorizes any supplier or back to provide UpTite Fasteners, Inc. all information requested about all accounts and obligations for which | or that company is a signatory. In consideration of extension of credit by UpTite Fasteners, Inc. I agree to terms of sale: 1% 10 days, net 30 days of shipment, and to pay at the rate of 18% per annum interest on past due accounts plus costs of collection and attorney's fees of not less that 15% of balance due.
I have read the above carefully and certify all the above stated is true and correct.
(Month)
(Day)
(Year)
(Officer)
(Title)
(Month)
(Day)
(Year)
(Guarantor)
(SS#)
(Month)
(Day)
(Year)
(Guarantor)
(SS#)
