Credit Application and Sales Agreement

General Information

Layout

Business Name / DBA *

Shipping Address *

Address Line 1

Address Line 2

City

State

Zip Code

Financial Contact Name

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business details

Telephone *

Type of Business

Fax Number *

Years in Business

Email to Remit Invoices *

Requested Credit Line

If corporation,

If a Corporation, Year of Incorporation

State of Incorporation

Subsidiary of

Owner/Officer Information

Owner / Officer Name *

SSN (If Partnership or Sole Proprietor)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Trade References

Company Name #1

Company Name

Telephone

Financial Contact Name

Fax

Company Name #2

Company Name

Telephone

Financial Contact Name

Fax

Company Name #3

Company Name

Telephone

Financial Contact Name

Fax

Bank References

Layout

Bank Name

Contact Name *

First

Last

Telephone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Layout

Commercial Checking Account Number

Loan Account Number

Signature of Owner/Officer

As an officer of the above named company, I do hereby give my consent to check any agencies or companies necessary in processing this credit and sales agreement. I certify that the above information is true and correct and in addition to the foregoing, promise to pay for all purchased in accordance with the terms of sale. I further agree to pay for all collection costs, to include reasonable attorney fees, incurred by Mueller Streamline Co. if made necessary by failure to comply with the payment terms of sale.

Signature *

Title *

Date / Time *

Attachments

PLEASE ATTACH CURRENT SET OF FINANCIAL STATEMENTS AND SALES TAX EXEMPTION CERTIFICATES. IF INCLUDING AN ATTACHMENT, SIGNATURES ARE STILL REQUIRED.

File Upload

Click or drag a file to this area to upload.

8285 Tournament Drive, Suite 150 • Memphis, TN 38125 • (901) 753-3200 • FAX (901) 759-7421