Application for Credit or General Information

OUR PREFERRED PAYMENT METHOD IS ACH FOR DOMESTIC USA ACCOUNTS OR WIRE FOR FOREIGN ACCOUNTS.

PLEASE CONTACT YOUR BANK TO ARRANGE FOR EITHER OF THESE ELECTRONIC OPTIONS USING OUR BANKING INFORMATION ON PAGE TWO OF THIS APPLICATION.

Billing Address

Company Name: *

Address:

Address Line 1

Address Line 2

City

State

Zip Code

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Country:

Phone:

Fax:

Email: *

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Accounts Payable Contact Name: *

First

Last

Phone:

Required

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Invoicing Email: *

WE REQUIRE AN EMAIL ADDRESS TO SEND YOUR INVOICES VIA PDF ATTACHMENT.

A/P Contact Email: *

WE REQUIRE AN EMAIL ADDRESS TO SEND YOUR INVOICES VIA PDF ATTACHMENT.

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D&B Number:

FEIN Number:

Years in business:

State Sales Tax Certificate Numbers(s):

CERTIFICATES MUST BE ATTACHED FOR USA CUSTOMERS

Operates as a:

Corporation
Partnership
Proprietorship

If a Proprietorship, Partnership or LLP, list below the name(s) of the owner(s):

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Name:

Have any of the owners or the company ever filed for bankruptcy?

Yes
No

Has a judgement ever been granted against the company?

Yes
No

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Expected Purchases Per Year:

Credit Line Requested

Trade References

*YOU MAY ATTACH YOUR OWN SHEET WITH THIS INFORMATION

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Name: *

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Location:

Address Line 1

Address Line 2

City

State

Zip Code

Phone:

Contact Person: *

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Bank Name: *

Account Number:

Street Address:

Address Line 1

Address Line 2

City

State

Zip Code

Loan Officer or Contact: *

First

Last

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Phone:

Fax:

Email: *

Banking Information

PLEASE READ CAREFULLY!

BANK OF AMERICA

Account number: 8670216511

Routing number ACH/EFT 071000039 ( USE FOR USA DOMESTIC PAYMENTS)

Routing number DOM. WIRES 026009593 (USE FOR FOREIGN WIRE PAYMENTS)

SWIFT Code INTL WIRES BOFAUS3N

REMITTANCE DETAILS SHOULD BE EMAILED TO ApplianceAR@Robertshaw.com

MAIN BANK LOCATION INFORMATION----FOR INFORMATIONAL PURPOSES ONLY!

DO NOT MAIL PAYMENTS TO THIS ADDRESS, ONLY TO BE USED FOR BANKING SET UP IF NEEDED

Bank of America

100 West 33rd Street New York , New York, 10001

ADDRESS BELOW IS OUR OFFICIAL REMITTANCE ADDRESS FOR PAYMENTS MADE BY CHECK ONLY

Robertshaw Controls Company

P.O. BOX 74007322 Chicago, Illinois 60674-7322

FOR OVERNIGHT PAYMENTS ONLY ==BY CHECK MADE PAYABLE TO ROBERTSHAW CONTROLS COMPANY:

Address the envelope to:

Robertshaw Controls Company, 7322

540 W. Madison, 4TH FLOOR Chicago IL 60661

IN ORDER TO COMPLETE YOUR APPLICATION, PLEASE CONFIRM WHICH ELECTRONIC METHOD YOUR COMPANY WILL BE USING TO PAY : *

ACH= FOR DOMESTIC ACCOUNTS ONLY
WIRE= FOREIGN ACCOUNTS ONLY

Review and Sign:

By signing below I/we agree:

All information furnished above is accurate.
Provide all aforementioned trade and bank references to supply credit information for the purpose of establishing or maintaining a credit account.
The extension of credit may be rescinded or altered by Robertshaw's credit department at any time from order acceptance, during the manufacturing period or at any time product is ready for shipment.
Applicant agrees to pay within the terms stated on the invoice and will pay collection fees in the event of default.
To prepay for shipments, if necessary, until credit has been established.
To provide financial statements, if necessary, to assess your company's credit worthiness.
In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all cost of litigation incurred.

Signature

Date

Name (Officer or Owner): *

First

Last

Title: