*If a field does not apply to you, please put NA in the text box.

Legal Business Name *

DBA *

Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Ship To Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Previous Address *

Phone *

Fax *

Mobile *

How Long In Business? *

Account Payable Contact *

Phone # *

Accounts Payable Email

Website: *

Amount of Credit Requested *

Fed Tax ID # *

Type of Business *

Flooring Dealer Trade Installer

Purchase Order Numbers Required (Note: Attach any special instructions) *

Yes No

*

Corporation Partnership Sole Proprietor LLC Limited Partner

TAX EXEMPTION STATUS

*If a field does not apply to you, please put NA in the text box.

Are You Tax Exempt? *

Yes No

* SALES TAX WILL BE BILLED UNLESS AN EXEMPTION OR TAX RESALE CERTIFICATE ACCOMPANIES THIS APPLICATION *

* In Addition - Tax Permits are required to be kept on file (with application) Per State Tax Laws for the following *

* Colorado, Louisiana & Oklahoma *

PRINCIPLE OWNERS - PARTNERS - OFFICERS

*If a field does not apply to you, please put NA in the text box.

* Partnerships/Corporations require a minimum of two Partner/Officer names

Full Legal Name *

First Name Last Name

Title *

Home Address - City - St - Zip *

Soc. Sec. No *

Drivers Lic. No *

Email Address

Mobile # *

Full Legal Name *

First Name Last Name

Title *

Home Address - City - St - Zip *

Soc. Sec. No *

Drivers Lic. No *

Email Address

Mobile # *

BANK REFERENCES

*If a field does not apply to you, please put NA in the text box.

Name *

Officer *

Address - City - State - Zip *

Account # *

Phone # *

Name *

Officer *

Address - City - State - Zip *

Account # *

Phone # *

TRADE REFERENCES

*If a field does not apply to you, please put NA in the text box.

Name *

Address - City - State - Zip *

Account # *

Phone # *

Name *

Fax # *

Address - City - State - Zip *

Account # *

Phone # *

Name *

Fax # *

Address - City - State - Zip *

Account # *

Phone # *

STANDARD TERMS AND CONDITIONS OF SALE

1. Buyer certifies that the above information is correct and complete, and that Buyer is solvent and able to pay within established payment terms. Buyer further understands that Seller will rely on this information for the extension of credit. Buyer authorizes Seller from time to time to obtain Business and Consumer Credit Reports on customer or any principals listed above or to obtain credit and funding information from any other persons or entities. This is not an agreement by Seller to lend money, it is an agreement by Buyer for the benefit of Seller, should Seller determine to supply materials or extend credit to Buyer in the future.

2. Seller may stop the manufacture or supply of any materials when it, in its sole discretion, determines that Buyer is in breach of this Agreement or any other contract with Seller, or Seller has insecurity with respect to Buyer's creditworthiness, until payment is made and any dispute or insecurity has been resolved. Buyer further agrees that Seller shall not, in any event, be responsible for any damage due to delay in supply of any materials.

3. Payment terms vary and are indicated on each invoice. Accounts not paid within terms become subject to credit hold and subject to collection. Buyer further agrees to pay all cost incurred in collection, including attorney's fees , if this account is placed with an attorney for collection, whether suit is filed or not. Buyer expressly agrees to submit to personal jurisdiction in Tarrant County, Texas, and agrees that this agreement is performable in Tarrant County, Texas, and the forum for any litigation arising out of or related to this Agreement or any other contract between Seller and Buyer, whether Seller or Buyer brings suit, shall be Tarrant County, Texas or in any other county at Seller’s discretion. This Agreement shall be governed by and construed in accordance with the laws of Texas.

4. Buyer will be responsible for payment on all amounts due under this agreement no matter what person or entity ordered the materials, until such time as the Seller receives written notice terminating agreement . Buyer shall notify Seller in writing of any agent not authorized to purchase under this agreement. Buyer shall also notify Seller of any change in the legal structure of business.

5. As to goods delivered by Seller's truck, title passes upon delivery at the place Buyer receives possession; and, thereafter, all risk of loss or damage, shall be on the Buyer. Deliveries by common carrier are f.o.b. shipping point. On direct shipment from manufacturers, title passes to Buyer at point and time of delivery to carrier ; and, thereafter, all risk of loss or damage shall be on the Buyer. Damage or shortage claims arising from direct shipment are to be made by Buyer against carrier . Seller assumes no responsibility beyond delivery to carrier in good order and is not responsible for loss, damage, or delay occurring thereafter. All items shown as freight allowed pertain to particular items and quantities. Any deviation after placement of order, such as changes in quantity or partial release, will be subject to the manufacturer's terms and conditions where applicable. Extra labor or mechanical facilities required to unload shall be provided by Buyer without any cost to Seller.

6. Seller assumes no responsibility for goods meeting any job specifications or requirements unless specifically so stated in its written quotation. Seller extends no warranties, written, oral, implied or statutory, relating to the goods sold. Any warranties for goods shall be obtained by and through the manufacturer.

7. Buyer agrees that any claims that charges reflected on invoices or statements are inaccurate are WAIVED if the charges are not contested within 30 days of the receipt of such statement or invoice. Normally stocked items in resalable condition will be accepted for credit subject to a 25% restock charge. Goods will not be accepted for return after 30 days from date of delivery. All returned goods must be accompanied by the original invoice and/or cash receipt. Special order items will not be accepted for return until Seller has secured permission and terms of return from Seller's source of supply.

8. I / We warrant that I am/we are authorized in my/our capacity to bind my/our firm accordingly.

*

I accept to the terms and conditions

Note: Two Partner/Officer signatures required for Partnerships or Corporations.

Company *

Printed Name *

Title *

Date *

Signature *

Printed Name *

Title *

Date *

Signature *

The undersigned Guarantor(s) in order to induce Lee-Wright, Inc. dba Professional Flooring Supply Co. (hereafter referred to as PFSCO) to extend credit to applicant, does hereby unconditionally personally guarantee all sums which may be owed by applicant to PFSCO whether said indebtedness is due now or hereafter incurred. This Guaranty is continuing and shall continue to apply to all indebtedness which applicant may hereafter incur, renew or extend in whole or in part with PFSCO all without notice to the undersigned Guarantor(s).

PFSCO may modify the indebtedness, accept or release collateral, or release the applicant without releasing the undersigned Guarantor(s). If the Guaranty is executed by more than one Guarantor, one or more Guarantors may be released, and such release shall not release the other Guarantor(s) and such release may be done without notice to the other Guarantor(s). The undersigned Guarantor(s) waives notice of execution of this Guaranty. Performance of this Guaranty shall be at Fort Worth, Tarrant County, Texas and the undersigned Guarantor(s) waives notice of execution of this indebtedness and obligation incurred hereunder at Fort Worth, Tarrant County, Texas.

Printed Name *

Home Address *

Phone # *

SS # *

Date *

Signature

Printed Name *

Home Address *

Phone # *

SS # *

Date *

Signature

Local Info

Select your Location *

Please attach your tax form

Enter the message as it's shown *

Business Credit Application

TAX EXEMPTION STATUS

PRINCIPLE OWNERS - PARTNERS - OFFICERS

BANK REFERENCES

TRADE REFERENCES

STANDARD TERMS AND CONDITIONS OF SALE

Note: Two Partner/Officer signatures required for Partnerships or Corporations.

Local Info