Credit Application – Clinton Electrical & Plumbing Supply

Prefer to fill the application out by hand? Click the button below to print a PDF and email to tina@cepsupply.com

Credit Application

Date *

Name *

First

Last

SS# *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Fax

If an individual doing business as (dba) or a partnership, list each principal or partner:

Name / Address / City / State / ZIP / Phone

Please add a semicolon between each individual.

If a corporation, for each principal officer state:

Name / Address / City / State / ZIP / Phone

Please add a semicolon between each individual.

Type of Business:

How Long in Business:

Credit Limit Desired:

Other suppliers that extend credit to you and your business:

Name / Address / City / State / ZIP / Phone & FAX *

Please add a semicolon between each individual.

Banks with whom your business maintains account or loan relationships:

Name & Type of Relationship / Address / City / State / ZIP / Phone *

Please add a semicolon between each individual.

Person for us to contact to discuss account or payment questions:

Name/Title *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Notice: By signing this application, I/we, individually and on behalf of the company named herein, authorize Clinton Electrical and Plumbing Supply, Inc., (CEP), its officers, employees or agents to inquire of any supplier or financial institution about my/our credit status. I/We further hereby and direct any supplier of financial institution, whether named herein or not, to release to CEP such credit information, and release may such supplier or financial institution from any and all liability with regards to the release of such information.

Date *

Name/Title *

The undersigned, in consideration of the extension of credit by Clinton Electrical and Plumbing Supply, Inc. to the above named applicant, hereby agree to be liable to Clinton Electrical and Plumbing Supply, Inc. for all goods, materials, and supplies charged to the account of said applicant until such time as Clinton Electrical and Plumbing, Inc. receives, in writing, notice from the undersigned that he/she is no longer responsible for any future charges against said account. Said cancellation of responsibility shall be prospective only. Upon receipt of such cancellation, Clinton Electrical and Plumbing Supply, Inc. may, at its option, at any time, in whole or part, cancel any additional extensions of credit to applicant; or may make such additional extensions of credit upon such terms and conditions as it, in its sole discretion, may determine. Where more than one person signs this clause, the liability created hereunder shall be joint and several.

Date *

Name/Title *

Name