Net 30 / Credit Application

USE THE FORM ON THIS PAGE TO SET UP NET30 TERMS

Need to fill out this application offline? No problem! Just download the Credit Application and email the completed form back to us at sales@cutandcouple.com or fax to (937) 454-2086

DOWNLOAD CREDIT APPLICATION

CREDIT APPLICATION

"*" indicates required fields

APPLICANT INFORMATION

Company Name*

How many years have you been in business?*

TAX ID#*

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number

Website

Please mark which one of the following applies...*

Corporation

Partnership

Individual

Incorporated within the past 12 months

INVOICE TO INFORMATION

Bill To Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Accounts Payable (A/P) Contact*

First Last

A/P Email*

A/P Phone*

Preferred method of payment - please check one*

ACH

Check

Credit Card (4% processing fee)

SHIPPING INFORMATION

Enter as many addresses as apply to you

Shipping Address #1*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address #2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address #3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Standard Shipping Method - generally less than 150 LBS

Standard Collect Account #

Preferred LTL Method - more than 150 LBS or pallet packaging

LTL Collect Account #

BUSINESS REFERENCES

REFERENCE #1 - Company*

REFERENCE #1 - Contact Name*

REFERENCE #1 - Contact Email*

REFERENCE #1 - Phone*

REFERENCE #1 - Fax

REFERENCE #2 - Company*

REFERENCE #2 - Contact Name*

REFERENCE #2 - Contact Email*

REFERENCE #2 - Phone*

REFERENCE #2 - Fax

REFERENCE #3 - Company*

REFERENCE #3 - Contact Name*

REFERENCE #3 - Contact Email*

REFERENCE #3 - Phone*

REFERENCE #3 - Fax

REFERENCE #4 - Company*

REFERENCE #4 - Contact Name*

REFERENCE #4 - Contact Email*

REFERENCE #4 - Phone*

REFERENCE #4 - Fax

SIGNATURE

Please review the information you have detailed above before signing.

By entering your NAME and DATE SIGNED below, you are certifying that all information on this form is correct and that you fully understand CUT & COUPLE's credit terms and agree to proper payment in consideration of extended credit. TERMS: Net 30 unless agreed upon by both parties.

Name of person filling out this form*

First Last

Date of signature*

SALES TAX EXEMPTION FORM

Please fill out the sales tax exemption form if applicable, otherwise the appropriate sales tax will be charged to all invoices. If you have your own Tax Exemption form, you may upload it using the file uploader located at the end of this form instead.

Sales and Use Tax Blanket Exemption Certificate

The purchaser listed above ("Vendor") hereby claims exception or exemption on all purchases of tangible personal property and selected services made under this certificate. The Vendor also certifies that the claim is based upon the purchaser's proposed use of the items or services, the activity of the purchase, or both, as listed below:

Vendor's Claim

Purchaser must state a valid reason for claiming exception or exemption

Purchaser's Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Signature

First Last

By entering your NAME above and DATE SIGNED below, you are certifying that all information on this Tax Exemption form is correct.

Date

Title of Signee

Vendor's License Number, if any

Vendors of motor vehicles, titled watercraft and titled outboard motors may use this certificate to purchase these items under the "resale" exception. Otherwise, purchaser must comply with either rule 5703-9-10 or 5703-9-25 of the Administrative Code. This certificate cannot be used by construction contractors to purchase material for incorporation into real property under an exempt construction contract. Construction contractors must comply with rule 5703-9-14 of the Administrative Code.

FILE UPLOADER - Attach your own pre-filled Tax Exemption form here

Max. file size: 5 MB.

FILE TYPES ALLOWED: .pdf, .doc, .docx, .jpg