WestPro Supply | Commercial Construction Material Supplier

Credit Application for Net 30 Terms

All information is held in the strictest confidence. Fields marked * are required. This is the same form available at westprosupply.com/credit.

Company Information

Company Legal Name *

Email Address *

Street Address *

City *

State *

Zip *

Contact Person

Contact Phone *

Company Type

Corporation

Partnership

Sole Proprietorship

LLC

Accounts Payable Contact

AP Contact Name *

AP Contact Email *

AP Contact Phone *

Ownership & Business Details

President / Owner Name

President Email

President Phone

Nature of Business

Years in Business

Federal Tax ID *

Contractor's License #

D&B #

Credit Amount ($) *

Bank Reference

Bank Name *

Account Number *

Bank Address

City

State

Zip

Bank Contact

Bank Phone

Bank Email

Bank Fax

Trade References

Reference #1

Company

Contact

Phone

Reference #2

Company

Contact

Phone

Reference #3

Company

Contact

Phone

Terms & Agreement

I HEREBY AUTHORIZE WESTPRO SUPPLY, LLC. (WPS), TO VERIFY ANY CREDIT INFORMATION PROVIDED BY THIS SOURCE DOCUMENT. I FURTHER AUTHORIZE OUR BANKS, TRADE REFERENCES AND FINANCIAL INSTITUTIONS THE RIGHT TO RELEASE BY TELEPHONE OR FAX ALL CREDIT INFORMATION REQUESTED BY WPS. WE UNDERSTAND THAT ANY INFORMATION OBTAINED BY WPS WILL BE HELD IN CONFIDENCE. THE REQUESTED INFORMATION WILL BE USED SOLELY IN ASSISTING AND SECURING CREDIT TERMS FOR THE APPLICANT. CREDIT PRIVILEGES ARE HEREBY REQUESTED AND IT IS UNDERSTOOD AND AGREED THAT UPON APPROVAL, THE TERMS OF PAYMENT ARE NET WITHIN 30 DAYS FROM THE DATE OF SHIPMENT. DELINQUENT ACCOUNTS ARE SUBJECT TO A FINANCE FEE OF 1.5% MONTHLY LATE CHARGE UNTIL ORDER IS PAID IN FULL. BUYER WILL ALSO BE CHARGED REASONABLE ATTORNEY'S FEES SHOULD COLLECTION BY SUIT BE REQUIRED.

We certify that the above information is true and correct, and that we can and will comply with WPS's terms.

Authorized Signer (Full Name) *

Title *

Date *

Electronic Signature — type your full name

By typing your full name above, you agree this constitutes your legally binding electronic signature.