Pipe Pipe -Structural • Steel• -Valves -Fittings Supplies ... Credit Application.pdf · 6385...
4
6385 Hwy87 E San Antonio, 78222 (210) 223-7473 (210) 223-7477 Fax 10243 Hwy290W Hye, 78635 (210) 868-0200 (830) 868-4549 Fax Pipe - Structural - Valves - Fittings - Fencing - Supplies Pipe • Sl• Supplies PIPEMOVERS.COM 2248 Hwy90W Hondo, 78861 (830) 741-2000 (830) 426-8999 Fax 409 Industrial Ave Robstown, TX 78330 (361) 767-7473 (361) 387-7477 Fax 103 Lafayee Drive Kerille, 78028 (830) 367-7473 (830) 367-3092 Fax 3145 N SH16 Hwy Jourdanton, 78026 (830) 769-1234 (830) 769-1230 Fax 6449 State Hwy359 Laredo, 78043 (956) 727-7473 (956) 727-7474 Fax Please complete enrely and return applicaon to [email protected] or fax to (210} 648-0785 CREDIT APPLICATION PREPARED BY :,_ _______ Amt. of Credit Requesng: ________ _ PMI SALES REP· ____ _ LEGAL BUSINESS/APPLICANT NAME: _________________ SSN/FEIN: ______ _ DB · _______________________________________ _ TDL#_· _________ PHONE #: ___________ E-MAIL_· ____________ _ MAIN ADDRESS: _______________ CITY, STATE & ZIP: ___________ _ ** SECTION BELOW IS FOR BUSINESS ACCOUN ONL* !LEGAL ENTITY: CORP [ ] PARTNERSHIP [ ] PROPRIETOR SHIP [ ] LLC [ ] LLP [ ] LLLP [ ] Govt [ 11 STATE OF INCORPORATION: YEAR BUSINESS STARTED: NAICS/SIC CODE: ----- ------ ------ PRODUCTS OR SERVICES OFFERED: _________________ PO REQUIRED? YES [ l NO [ T EXEMPTED: SALES TAX EXEMPT CERTIFICATE [ ], RESALE CERTIFICATE [ ], OR DIRECT PAY CERTIFICATE [ ] ***PLEASE PROVIDE CERTIFICATE, EXEMPTION NUMBER ALONE WILL NOT BE ACCEPTED*** TX SHIPPING ADDRESS: ________________ CITY, STATE, & ZIP: _________ _ If Different From Main BILLING ADDRESS: _________________ CITY, STATE, & ZIP: _________ _ 1) Name Title 2 ) Name Title 3) Name Title 4) Name Title OFFICERS (OWNERS/PARTNERS/MEMBERS) Required Phone Phone Phone Phone DL# Filed or Adjudged Bankruptcy? DL# Filed or Adjudged Bankruptcy? DL# Filed or Adjudged Bankruptcy? DL# Filed or Adjudged Bankruptcy? PURCHASING CONTACT: _ _____ _____ _____ _____ ________ _ Print Name Phone E-mail ACCOUNTS PAYABLE: _______________________________ _ Print Name Phone E-mail Page 1 of 3
-
Upload
trinhnguyet -
Category
Documents
-
view
238 -
download
0
Transcript of Pipe Pipe -Structural • Steel• -Valves -Fittings Supplies ... Credit Application.pdf · 6385...
6385 Hwy87 E San Antonio, TX 78222
(210) 223-7473(210) 223-7477 Fax
10243 Hwy 290 W Hye, TX 78635 (210) 868-0200
(830) 868-4549 Fax
Pipe - Structural - Valves - Fittings - Fencing - Supplies
Pipe • Steel• Supplies PIPEMOVERS.COM
2248 Hwy90W Hondo, TX 78861 (830) 741-2000
(830) 426-8999 Fax
409 Industrial Ave Robstown, TX 78330
(361) 767-7473(361) 387-7477 Fax
103 Lafayette Drive Kerrville, TX 78028
(830) 367-7 473(830) 367-3092 Fax
3145 N SH 16 Hwy Jourdanton, TX 78026
(830) 769-1234(830) 769-1230 Fax
6449 State Hwy 359 Laredo, TX 78043 (956) 727-7473
(956) 727-7474 Fax
Please complete entirely and return application to [email protected] or fax to (210} 648-0785
CREDIT APPLICATION
PREPARED BY :, ________ Amt. of Credit Requesting: _________ PMI SALES REP·,__ ____ _
LEGAL BUSINESS/APPLICANT NAME: _________________ SSN/FEIN: ______ _ DB,,_· _______________________________________ _
TDL#_· _________ PHONE #: ___________ E-MAIL_· ____________ _
MAIN ADDRESS: _______________ CITY, STATE & ZIP: ___________ _
** SECTION BELOW IS FOR BUSINESS ACCOUNTS ONLY**
!LEGAL ENTITY: CORP [ ] PARTNERSHIP [ ] PROPRIETORSHIP [ ] LLC [ ] LLP [ ] LLLP [ ] Govt [ 11
STATE OF INCORPORATION: YEAR BUSINESS STARTED: NAICS/SIC CODE: ----- ------ ------
PRODUCTS OR SERVICES OFFERED: _________________ PO REQUIRED? YES [ l NO [
TAX EXEMPTED: SALES TAX EXEMPT CERTIFICATE [ ], RESALE CERTIFICATE [ ], OR DIRECT PAY CERTIFICATE [ ] ***PLEASE PROVIDE CERTIFICATE, EXEMPTION NUMBER ALONE WILL NOT BE ACCEPTED***
TX SHIPPING ADDRESS: ________________ CITY, STATE, & ZIP: _________ _ If Different From Main
BILLING ADDRESS: _________________ CITY, STATE, & ZIP: _________ _
1)
Name Title
2) Name Title
3) Name Title
4) Name Title
OFFICERS (OWNERS/PARTNERS/MEMBERS) Required
Phone
Phone
Phone
Phone
DL# Filed or Adjudged Bankruptcy?
DL# Filed or Adjudged Bankruptcy?
DL# Filed or Adjudged Bankruptcy?
DL# Filed or Adjudged Bankruptcy?
PURCHASING CONTACT: _____________________________ _ Print Name Phone E-mail
ACCOUNTS PAYABLE: _______________________________ _ Print Name Phone E-mail
Page 1 of 3
