Ordering
Terms of Sale
Customer Order Form
RGA Request Form
California Resale Certificate
Credit Application
   Credit Application

Company Name
Legal Name
DBA
Billing Address
Shipping Address

Phone

Fax

Corp.

Partnership

Individual

Year Established

Type of Business

How Long in Business

Principals

Title
Title
Title
Has the firm or any of its Principals ever been bankrupt? Yes No
If yes, please explain

Bank

Name

Account #

Address
Phone

Type of Account

 
Name

Account #

Address
Phone

Type of Account

Trade References

Name
Address
Phone

Fax

 
Name
Address
Phone

Fax

 
Name
Address
Phone

Fax

 
Name
Address
Phone

Fax

 
Are you listed with Dun & Bradstreet? Yes No
Taxable Yes No

Please note that we are required, by law, to charge Sales Tax on all sales unless we have a resale certificate on file in our office.

Accounts Payable Contact Phone

The undersigned will/will not submit a financial statement. Any misrepresentation in this application will be considered evidence of a fraud, since this information is the basis for the granting of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed.

Authorization signature to release bank information

Personal Guarantee of a Contract-Single Guarantor:

In consideration of signing the above contract with ROC Industries, I personally guarantee the performance of obligations of , in the above contract.

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Address
City State Zip