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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

Company Address:


Business Information

Monthly $
Annual $

Trade Reference:

Trade Reference:

Trade Reference:

Bank Reference:

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.