Alliance Flooring Service

Customer Information Form

Company Name & Management Company

What year was the business established?

Contact Person

Address

Phone

Billing Address (If different from above)

Accounts Payable Contact (name and phone/email)

Federal Tax ID: Type of Business

Individual

Sole Proprietor

Partnership

Corporation

Are you tax-exempt? If yes, please attach the reseller permit:

Yes

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Authorized Purchasers:

Trade References: Please include a minimum of 2 with name, address and phone number.

General Terms and Conditions:

Applicant acknowledges that this information has been submitted with knowledge that it will be used in evaluating the extension of credit to the applicant. Applicant acknowledges that Alliance Flooring Services may inquire with trade references on payment history. I have read the terms and conditions stated below and agree to all of these terms and conditions.

General Terms and Conditions

Bills are sent as work is completed. Invoices are net 30 days from the date of invoice
A service charge of 1.5% per month will be added to all amounts that are 31st day delinquent
No Additional Credit will be extended to past-due accounts unless satisfactory arrangements are made with our credit department.
I agree that if my account must be placed in the hands of an attorney for collection, if collection is made through a probate proceeding, I will pay reasonable costs of collection, including attorney's fees.

Authorized Signature

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Printed Name

Title

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