Credit App - Fuller Supply Company

Billing Information
First Name/Company Name*
Last Name/Company Name*
Date
MM slash DD slash YYYY
Billing Address*
Street Address City State ZIP
Cell Phone*
Business Phone
Email
Shipping Information
Company Name*
First Last
Shipping Address*
Street Address City State ZIP
Specific Delivery Location on Property
Biling Preference (to be sent)*
- US Mail
- Fax
- Email

Please list four business references with whom you have open accounts with:
Name*
First
Address
Street Address City State / Province / Region ZIP / Postal Code
Name
First
Address
Street Address City State / Province / Region ZIP / Postal Code
Name
First
Address
Street Address City State / Province / Region ZIP / Postal Code
Name*
First
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Can partial orders be shipped?
- Yes
- No
Do You Allow Back Orders*
- Yes
- No
Are Written Purchase Orders Required?
- Yes, Always
- Blanket Purchase Order #
- Verbal Or Other
Please list the people who are authorized to charge against your account:
Name
Name Title
Name
Name Title
Name
Name Title
TERMS: F.O.B. GRAND RAPIDS
2% 10th Prox., NET 30 (2% DISCOUNT IF THE CHECK IS RECEIVED BY THE 10TH OF THE MONTH)

FINANCE CHARGE: ACCOUNTS NOT PAID WITHIN 30 DAYS WILL, ON THE BILLING DATE FOLLOWING, BE CHARGED 1.7% EACH MONTH, WHICH IS 20.4 ANNUAL PERCENTAGE RATE. MINIMUM OF $3.00 PER MONTH.

-- MERCHANDISE RETURNED FOR CREDIT IS SUBJECT TO A 15% RESTOCKING FEE
-- MINIMUM CHARGE $15.00.
-- WE ACCEPT VISA/MASTERCARD AS A CASH SALE (MINIMUM CHARGE $15.00 - NO DISCOUNT ALLOWED)

In the event the account is turned over to an attorney or other agency for collection, or suit is brought on same, or the same is collected through any judicial proceeding whatsoever, purchaser shall pay service charges, all reasonable collection fees, attorneys' fees and court cost incurred by seller.

SIGN BELOW TO AGREE:
Signature*
2% 10TH Prox., NET 30 (2% DISCOUNT IF THE CHECK IS RECEIVED BY THE 10TH OF THE MONTH) ACCOUNTS NOT PAID WITHIN 30 DAYS WILL, ON THE BILLING DATE FOLLOWING, BE CHARGED 1.7% EACH MONTH, WHICH IS 20.4% ANNUAL PERCENTAGE RATE. MINIMUM OF $3.00 PER MONTH. MERCHANDISE RETURNED FOR CREDIT IS SUBJECT TO A 15% RESTOCKING FEE MINIMUM CHARGE $15.00. WE ACCEPT VISA/MASTER CARD AS A CASH SALE (MINIMUM CHARGE $15.00 - NO DISCOUNT ALLOWED) In the event the account is turned over to an attorney or other agency for collection, or suit is brought on same, or the same is collected through any judicial proceeding whatsoever, purchaser shall pay service charges, all reasonable collection fees, attorneys’ fees and court cost incurred by seller. Purchaser agrees that seller may obtain financial and credit reports on the business and principles/officers from any lending institution and/or credit reporting bureaus at any time.
Corporate Officer (CEO,CFO,COO, PRESIDENT, VP)*
SIGNATURE OF THE COMPANY OFFICER IS REQUIRED TO GET CREDIT APPROVED

I HEREBY GIVE MY PERMISSION TO RELEASE ANY CREDIT INFORMATION REQUESTED BY FULLER SUPPLY COMPANY.
Name
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1958 Turner Avenue NW Grand Rapids, Michigan 49504-2034

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Veteran-Owned Company

Credit Application

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1958 Turner Avenue NW Grand Rapids, Michigan 49504-2034

Contact Information

Need Credit?

Serving all of Michigan & beyond

Veteran-Owned Company

Serving all of
Michigan & beyond