Charge Account Application

My Store*

Company/Organization Name*

Bill To*

Street*

City*

State*

Zip Code*

Accounts Payable Contact*

Phone Number*

Fax Number

Dun & Bradstreet

Business Focus*

I approve emailed invoices in lieu of mailing.*

Yes No

Email Address for Billing*

Ace Rewards # (If applicable) Not sure of your Ace Rewards number? Check your most recent Rewards certificate.

If you are tax exempt, please attach a blanket tax exemption certificate.

Tax Exemption Number

Tax Exemption Reason

Is a purchase order required for each purchase?*

Yes No

Note: If you select YES, our system will not allow an account purchase without a purchase order

Is an authorized signer required for each purchase?*

Yes No

Note: If you select YES, our system will only allow an authorized signer to make purchases. If you select NO, all purchases made on your account will be your responsibility.

Additional Authorized Signer

Credit References

Bank Name*

City/State/Zip*

Phone*

Fax

Credit Reference

City/State/Zip

Phone

Fax

Credit Reference

City/State/Zip

Phone

Fax

Credit Reference

City/State/Zip

Phone

Fax

Credit Reference

City/State/Zip

Phone

Fax

Payment is due upon receipt of monthly statement. The undersigned understands that a 1-1/2% monthly finance charge (18% annually) may be added to any balance over 30 days. In the event of default, the undersigned promises to pay legal interest on the indebtedness, together with such collection costs and reasonable attorney fees as may be required to affect collections.

All information collected is done so exclusively with your consent, and only to communicate with you and your company in regards to your Business Account. We will send invoices, statements and from time to time special offers or pricing. We will not, in any circumstances, share your information with other individuals or organizations without your permission, including public organizations, corporations or individuals, except when applicable by law.

Credit References

Commercial