Credit Application Business Name * Website * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Owner's Name * Phone * Accounts Payable Contact * Phone * Dunn & Bradstreet Number * Contractor Number * Resale Number * Federal Tax ID We're a: * Individual Partnership Sole Proprietor Corporation Type of Business * Date Started * Bank Reference * Phone * Provide 3 credit references Name * Name First First Last Last Phone * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal plus1 Add minus1 Remove By initialing in each section below, I accept responsibility and agree to these terms: I certify that all the information is true and correct. * signature keyboard Clear I authorize Picatti Brothers Inc. to contact credit references and/or run a credit history with a local Credit Bureau if necessary. All information is confidential and strictly for establishment of appropriate credit limits with Picatti Brothers Inc. Invoices are due upon receipt. * signature keyboard Clear Customers may request a payment schedule to pay the balance (including interest) over time of a monthly payment schedule with payments due on the first of each month. Customer agrees to pay interest at the rate of 18% per year on any financed balance. Payments not received by the 10th of the month will be charged a late fee of $25. Interest will continue to accrue and be due with any past due balance. Should it become necessary to turn this account over to a collection agency or an attorney for legal remedy, customer is subject to all collection charges, including but not limited to, reasonable attorney fees, court costs, and collection fees not to exceed 35% of the commercial collection claim. The venue for any collection, or legal action brought, will be within Yakima County, Washington State. By signing this document, you are stating that you understand these terms. * signature keyboard Clear In the event that credit is extended, applicant acknowledges that this credit application is also a binding contract between the parties, fully effective for all transaction between the parties. The customer by signing agrees to pay in accordance with the invoice terms. For Commercial Accounts Only: signature keyboard Clear The named herein customer accepts full responsibility for payment of invoices when any person(s) representing said customer acts on their behalf as a representative. It is understood that the representative is authorized to sign for and pick up merchandise that has been ordered by customer. Authorized Signature * signature keyboard Clear reCAPTCHA If you are human, leave this field blank. Send Δ
