Central Builders Supply Company

1
Business Information
2
Ownership Information
3
Trade
References
4
Bank
References
5
Authorization

1/5

Business Information

Contact Information

Company Name*

Billing Address*

City*

State*

Zip*

Phone*

Fax

Email*

Contact Person*

Other Business Information

Type of Business*

If Corporation, Which State?

Years Business Established*

Number of Employees

Sales Volume

Credit Information

Federal Tax ID*

DUNS Number

Credit Line Requested*

Ownership Information

Owner Name*

Address*

City*

State*

Zip*

Phone*

Email*

25%

Trade References

Please add three trade references

Company Name*

Years Doing Business*

Address*

City*

State*

Zip*

Phone*

Fax

Email*

Add Trade Reference

Company Name

Years Doing Business

Address

City

State

Zip

Phone

Fax

Add Trade Reference

Company Name

Years Doing Business

Address

City

State

Zip

Phone

Fax

50%

Bank References

Bank Name*

Address*

City*

State*

Zip*

Phone*

75%

Authorization

We hereby apply for credit and affirm financial responsibility, ability, and willingness to pay invoices in accordance with published terms. The above information is warranted to be true and complete. We hereby authorize you to verify and collect information on us, including but not limited to bank references, trade credit references, consumer and/or commercial credit reports. We agree to pay all costs of collection and litigation on this account in accordance with the laws of the Creditor's State of Incorporation. We agree that all decisions with respect to the extension or continuation of credit shall be the sole discretion of the Creditor.

I have read the terms and conditions stated below and agree to all of these terms and conditions.

General Terms and Conditions

1%/10 Days, Net 30
A service charge of 1.5% per month will be added to all amounts billed if not paid by the end of the month.
No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit dept.

Submitter Name*

Submitter Title*

Submitter Signature

100%

Credit Application

Download: Credit Application
Mail to: 125 Bridge Avenue
Sunbury, PA 17801
Email to: creditdept@centralbuilderssupply.com
Fax: (570) 286-5108