NEW CUSTOMER SETUP & CREDIT APPLICATION

Name of Person Completing Form*

Email of Person Completing Form*

Business Name*

Billing Address*

Street Address City State / Province / Region ZIP / Postal Code

Shipping Address

Same As Billing Address

Street Address Address Line 2 City State / Province / Region

Phone*

Year Established*

A/P Contact*

A/P Email Address*

A/P Phone*

TYPE OF BUSINESS*

Corporation

Partnership

Sole Proprietorship

State of Incorporation

Sales Tax Exemption ?*

Yes

Sales Tax Exemption #*

Copy of Sales Tax Exemption Certificate

Max. file size: 32 MB.

Taxpayer Identification #

(A copy of your sales tax exemption certificate must accompany this application. Failure to comply will result in tax being charged to all order.)

Dun & Bradstreet #

Brief Description of Business & Products:

Business Type:*

Manufacturer

Distributor

Machine Builder

Other

Complete Next Section ONLY If Applying For Credit / Payment Terms*

Are you applying for Credit / Payment Terms?

Yes

Hidden

Section Break

If you wish to upload a PDF containing your credit information, you may skip this section*

Do you prefer to upload a document containing your credit information?

Yes

Please Select Files to Upload*

Upload Company Banking and Credit information and Tax Exempt Certificate (if applicable)

Drop files here or

Accepted file types: jpg, gif, png, pdf, xls, xlsx, doc, docx, Max. file size: 20 MB.

Hidden

Section Break

OWNERS & PRINCIPAL OFFICERS OF FIRM

Name

Title

Name

Title

Name

Title

TRADE REFERENCES

Only submit those with whom you have an open account

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

BANK REFERENCES

MUST INCLUDE ACCOUNT NUMBERS

Bank Name

Account Contact

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number

Checking Account Number(s)

Hidden

Section Break

I understand the following and will abide by your company regulations:

Notify REI of any changes in ownership of our company.
If granted credit, our company agrees to pay all invoices within 30 days of invoice date.
It is agreed that our company will pay 1.5% per month which is 18% yearly for all past due balances.
It is agreed that our account will become COD if we fail to pay invoices within the above stated terms.
Our company financial condition is satisfactory and we can meet all financial obligations.
There are no lawsuits or judgments against me at this present time. If our company defaults on payment of any Outstanding valid invoices, we agree to pay attorney and/or collection expenses.
If applying for credit terms, I agree to allow REI to research my credit history.

Title

Print Name

Signature(Type Full Name)

Date

Untitled

First Choice

Second Choice

Third Choice

Name of Person Completing Form*

Email of Person Completing Form*

Business Name*

Billing Address*

Street Address City State / Province / Region ZIP / Postal Code

Shipping Address

Same As Billing Address

Street Address Address Line 2 City State / Province / Region

Phone*

Year Established*

A/P Contact*

A/P Email Address*

A/P Phone*

TYPE OF BUSINESS*

Corporation

Partnership

Sole Proprietorship

State of Incorporation

Sales Tax Exemption ?*

Yes

Sales Tax Exemption #*

Copy of Sales Tax Exemption Certificate

Max. file size: 32 MB.

Taxpayer Identification #

(A copy of your sales tax exemption certificate must accompany this application. Failure to comply will result in tax being charged to all order.)

Dun & Bradstreet #

Brief Description of Business & Products:

Business Type:*

Manufacturer

Distributor

Machine Builder

Other

Complete Next Section ONLY If Applying For Credit / Payment Terms*

Are you applying for Credit / Payment Terms?

Yes

Hidden

Section Break

If you wish to upload a PDF containing your credit information, you may skip this section*

Do you prefer to upload a document containing your credit information?

Yes

Please Select Files to Upload*

Upload Company Banking and Credit information and Tax Exempt Certificate (if applicable)

Drop files here or

Accepted file types: jpg, gif, png, pdf, xls, xlsx, doc, docx, Max. file size: 20 MB.

Hidden

Section Break

OWNERS & PRINCIPAL OFFICERS OF FIRM

Name

Title

Name

Title

Name

Title

TRADE REFERENCES

Only submit those with whom you have an open account

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

Name

Account Contact

Phone Number

BANK REFERENCES

MUST INCLUDE ACCOUNT NUMBERS

Bank Name

Account Contact

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number

Checking Account Number(s)

Hidden

Section Break

I understand the following and will abide by your company regulations:

Notify REI of any changes in ownership of our company.
If granted credit, our company agrees to pay all invoices within 30 days of invoice date.
It is agreed that our company will pay 1.5% per month which is 18% yearly for all past due balances.
It is agreed that our account will become COD if we fail to pay invoices within the above stated terms.
Our company financial condition is satisfactory and we can meet all financial obligations.
There are no lawsuits or judgments against me at this present time. If our company defaults on payment of any Outstanding valid invoices, we agree to pay attorney and/or collection expenses.
If applying for credit terms, I agree to allow REI to research my credit history.

Title

Print Name

Signature(Type Full Name)

Date

Untitled

First Choice

Second Choice

Third Choice

NEW CUSTOMER SETUP & CREDIT APPLICATION