Untitled Document
Partnership/Limited Liability Partnership
Application for Open Account

* - required fields
________ Initial




Corporate office
Waukesha-Pearce Industries, Inc.
P.O. Box 35068
Houston, Texas 77235-5068
ATTN: Credit Department

Fax Completed Form to (713) 551-0435
If any questions,
call our Credit Department (713) 551-0362

Branch Office Salesman Rush Order
* Firm or Trade Name
* Mailing Address
* City
* State
* Zip
* Telephone
* Fax
* State ID Number
* State
* Partner
* Partner
Partner
Partner
Financial Statement
If Yes, please fax copy.
Preseason Program Floor Plan
* Dba or Aka
* Street Address
* City
* State
* Zip
* Business Classification
* Type of Business
* How long in business?
Affiliates (if any)
* Social Security Number
* Social Security Number
Social Security Number
Social Security Number
* Exemption Certificate
If Yes, please fax copy.

* Purchase Order Required?

If Yes, authorized signature(s) required.
Trade References:
(Minimum of 2)
* Name
* Account
Number
* Phone
* Address
* City
* State
* Zip
* Name
* Account
Number
* Phone
* Address
* City
* State
* Zip
Name
Account
Number
Phone
Address
City
State
Zip
Bank Reference
* Bank Name * Bank Officer
* Telephone Number * Account Number
* Street Address * Line Of Credit
* City * Loan Number
* State * Secured
* Zip * Unsecured

WPI’S STANDARD TERMS ARE NET 30 DAYS FROM THE INVOICE DATE EXCEPT RENTAL AND UNIT SALES ARE DUE UPON RECEIPT OF INVOICE.

Our Credit Department will establish a credit limit covering your monthly purchases based on credit information that you are furnishing. Purchases in any one month in excess of established credit limit will require credit authorization from our Credit Department in Houston. Credit Department authorization will also be required any time account becomes delinquent. All charges are payable at P.O. Box 4550, Houston, Texas 77210.

A SERVICE CHARGE NOT TO EXCEED THE LEGAL RATE PRESCRIBED BY STATE LAW WILL BE CHARGED WHEN ACCOUNTS EXCEED OUR STANDARD TERMS OF SALE. THIS RATE WILL NOT BE LESS THAN ONE PERCENT (1%) OF THE BALANCE DUE FOR EACH 30-DAY PERIOD OF DELINQUENCY.

I hereby authorize all banks, lending institutions, trade references, or credit associates to discuss with or to release to Waukesha-Pearce Industries Inc., any and all information which they may have pertaining to my credit, financial dealings or transactions, or other similar information. I hereby authorize Waukesha-Pearce Industries, Inc. permission to obtain consumer credit reports in connection with my credit application for approval of commercial business transactions with Waukesha-Pearce Industries, Inc. I authorize Waukesha-Pearce Industries, Inc., to notify any general contractor owner, bond company or other involved party in the extension of credit to me involved for the purpose listed. This notification may occur before, during or after the credit is extended. This authorization is given to aid in determining whether and under what terms to extend credit to me from Waukesha-Pearce Industries, Inc.

Date Applicant (Printed Name)
Authorized Signature Title
Complete, Print, Initial Page 1, Sign, and Fax to (713) 551-0435.
IF ANY QUESTIONS CALL THE CREDIT DEPARTMENT (713) 551-0362.

PH: 713.723.1050 FX: 713.551.0454 | P.O. Box 35068 | 12320 South Main Street | Houston, TX 77235-5068

© Copyright 2007 Waukesha-Pearce Industries, Inc. All Rights Reserved.