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    Customer Profile Sample

    Uploaded by

    Grace Todd
    Customers sample

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Customer Profile Sample

    Uploaded by

    Grace Todd
    0 views1 page
    Customers sample

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Customers sample

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    0 views1 page

    Customer Profile Sample

    Uploaded by

    Grace Todd
    Customers sample

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    CUSTOMER

    Acct Number: ____________ PROFILE

    Name of Firm:

    Billing Address:
    (Telephone #)
    Shipping Address:
    (Fax #)

    Buyers E-Mail Address: Web Page:


    Type of Business: Corporation: Partnership: Sole Owner:
    Date Incorporated: State: Fed Tax ID #:
    No. of Office Workers: Number of Years in Business:
    Names of Owners, Partners, or Officers:
    If Branch, location of home office: Where are bills paid?:

    Who is the person to contact regarding Accounts Payables:


    A/P Contact Persons E-Mail Address:
    Name(s) of persons authorized to charge:
    TAX EXEMPT? Yes No REQUIRE A PURCHASE ORDER? Yes No
    If yes, please attach Tax Certificate. Listed with Dun & Bradstreet? Yes No
    We expect out monthly purchases to be: $ Dun & Bradstreet Number:
    Would your company like monthly statements? Yes No
    Bank References: Personal charge accounts and credit cards are NOT acceptable References.

    (Name) (Street & Address) (City/State/Zip) (Account #) (Telephone #)

    (Name) (Street & Address) (City/State/Zip) (Account #) (Telephone #)

    Trade references:

    (Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)

    (Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)

    (Name) (Street & Address) (City/State/Zip) (Telephone #) (Fax #)


    Our Credit terms are: "Due upon receipt of invoice". Accounts 30 days or more past due may be charged interest
    at the rate of 1 1/2% per month or the maximum legally allowable rate in the purchasers state of residence.
    Accounts 45 days or more past due may not receive shipments until account is current unless other arrangements
    are made in writing with our Accounts Receivable Department. Accounts 90 days past due may be placed with a
    collection agency and credit charges, court costs and reasonable attorney fees may be added to amount due
    unless other arrangements are made with our Accounts Receivable Department.
    This credit application is complete and accurate to the best of my knowledge. I have read, understood, and agree
    to abide by the terms and conditions as stated in this document.

    Signature of Authorized Agent:


    Name Title

    Yes I would like to receive promotions, announcements, invitations, and special offers from Reliant.
    Please fax completed application back with signature to 713-425-5820.
    Phone: (713) 425-5819 Customer Profile Revised: 09/03/16

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