Credit Application – Barksdale Sales Group

Instructions:
1. Please complete all sections above.
2. Please attach a copy of your company’s latest financial statements.
3. Please attach a Resale Certificate or A Sales Tax Exemption Certificate if you do not wish to be charged sales tax.
4. Please complete the reverse side credit and trade reference or attach comparable information fact sheet.
5. Please email to setup@rectorseal.com.

Company Address:

Company Name

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Shipping Address

Address Line 1

Address Line 2

City

State

Zip Code

Telephone

Fax Number

Email Address

Officers/Owners:

Layout

President/Owner:

First

Last

Chief Financial Officer:

First

Last

Senior Purchasing Officer:

First

Last

Senior Sales Officer:

First

Last

Business Information

Layout

Date of Incorporation:

State of Incorporation:

Type of Incorporation

Corporation
Partnership
Proprietorship

Layout

Accounts Payable Manager Name: *

First

Last

Accounts Payable Manager Contact Number:

Accounts Payable Manager Email: *

Layout

Federal I.D Number:

Approximate Amount of Purchases:

Monthly $

Sales Tax ID or Exemption Permit Number:

Approximate Amount of Purchases:

Annual $

Trade Reference:

Name of Company: *

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Key Contact: *

First

Last

Layout

Telephone:

Fax Number:

Email Address: *

Trade Reference:

Name of Company: *

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Key Contact: *

First

Last

Layout

Telephone:

Fax Number:

Email Address: *

Trade Reference:

Name of Company: *

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Key Contact: *

First

Last

Layout (copy)

Telephone:

Fax Number:

Email Address: *

Bank Reference:

Name of Bank: *

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Account Number:

Key Contact: *

First

Last

Layout

Telephone:

Fax Number:

Email Address: *

Company Representative Signature:

This information herein is submitted to Rectorseal for the purpose of establishing an account. The undersigned hereby authorizes. Rectorseal and its agents to disclose this information in confidence to the banks and trade references provided to facilitate the establishment of a credit account. If credit is extended based upon these representations, undersigned agrees to pay any obligations due in accordance with the terms of sale shown on the invoice. Undersigned further agrees to pay reasonable attorney fees and any court costs in the event that suit is required to collect any unpaid past due invoices.

Name *

First

Last

Signature

Date