This is a printable version of the Halsted & Hoggan, Inc. credit application. Please print it out and fax it to 213-623-5527.
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Company Name: |
DBA: |
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Description of Business: |
Year Established: |
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Tax Status: Taxable/Resale/Exempt |
Type of Business: Corporation/Partnership/Individual |
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Billing Address: |
Shipping Address: |
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Billing City/State/Zip |
Shipping City/State/Zip |
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Telephone: |
Fax: |
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URL Address: |
Email: |
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Accounting Contact/Extension: |
Sales Contact/Extension: |
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Business Checking Bank: |
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Business Checking Account#: |
Bank Contact: |
Terms: Net thirty (30) days from date of invoice. A two percent (2%) service charge is charged per month on all past due invoices. Applicant agrees to pay all charges for account or others using this account regardless of its credit limit. Applicant will pay all collection costs including attorney’s fees.
REFERENCES
Only vendors that have your company on open account/ 3 references minimum
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Contact Person: |
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If your
purchases are for resale please complete the following:
RESALE CERTIFICATE
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The undersigned hereby certifies that all PUMPS, SERVICE PARTS, PUMP ACCESSORIES, WINDMILL, WELL SUPPLIES AND ACCESSORIES and/or MOTORS hereafter purchased is/are for the purposes of resale, and assumes all liability for the payments required by Sales and Use Tax Law with respect to receipts from the resale of the purchased property. Unless otherwise specified this certificate shall be considered a part of each verbal or written purchase order placed with Halsted & Hoggan, Inc. 935 S. Santa Fe Ave. Los Angeles, CA 90021. |
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Valid Seller’s Permit No.: ________________________________________________________________ Signature: ___________________________________________Title: _____________________________ Name of Purchaser: ____________________________________________________________________ Mailing Address of Purchaser: ___________________________________________________________ City/State/Zip: ________________________________________________________________________ Phone: ________________________________________Fax: ____________________________________ E-Mail: ______________________________ Web Address: ____________________________________ |