New Account Credit Application


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 Welcome to Piedmont Office! If you are interested in setting up an online ordering account with us, please fill out this form and fax it back to us. A customer service representative will contact you about your application once it has been received. Thank You!
Company:
  

Company Address:

  
City / State / Zip :
  
Telephone:
  

Fax:

  
Shipping Address:
(if different than above)
  
Name of Business Owner(s):
  
Name of Accounts Payable Contact:
  
Telephone:
  
Name of Buyer:
  
Telephone:
  
Are products purchased for resale or tax exempt?:
  
Resale or Tax Exempt Number:
  
Type of Business:
  
Years in Business:
  

Trade References
Name Account Number(s) Telephone
     
     

Bank References
Bank Name & Address Account Number(s) Contact Name & Telephone

 

    

 

    

Terms of Sale and Agreement
Applicant(s) agrees to pay all monies due within 20 days from date of invoice. A finance charge of 1 1⁄2 % per month, will be charged on all delinquent accounts. Should Applicant default on terms and legal action become necessary, the Applicant(s) agrees to pay all collection expenses including administrative costs, court costs and attorney’s fees.

Applicant will inform Piedmont Office Suppliers (in writing) of any change in company name, address or phone number as soon as such changes occur.

The information given is warranted to be true and Applicant authorizes the release of all pertinent information necessary for processing the applicant’s request for credit including bank records and other financial data.

Please, Only authorized signature can be accepted (CEO, VP Level Executive, Controller or Owner)
Print Name:

 
Title:
  
Signature:

 
Date: