Credit Application

If you are interested in opening a credit account with us, please fill out this form completely. Our Accounting Department can be reached at 800-660-4455 between 8am to 5pm EST Monday-Friday. We will respond to your request within three business days via phone or email.

Date

Company Name

Primary Contact Name*

Prefix First Last

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Company Website

Entity Type*

Sole Trader
Partnership
Limited Liability

In Business Since*

Officer/Principal (1) Information

Name*

Prefix First Last

Title*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Officer/Principal (2) Information

Name

Prefix First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Financial Information

Bank Name*

Account #*

Credit Limit Requested*

Bank Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Phone*

Accounts Payable Email for Invoices and Statements*

Trade Reference 1

Company Name*

Contact Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Phone*

Contact Email*

Trade Reference 2

Company Name*

Contact Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Phone*

Contact Email*

Additional Details

Authorized Individuals*

Please enter the first and last name of individuals you authorize to charge against your account. Please note, it is your responsibility to notify Schmidt's Wholesale, Inc. in the event this information changes.

Purchase Order # or Job Name required for all purchases?*

Yes
No

If you are Tax Exempt - please attach a copy of your paperwork here.

Drop files here or

Accepted file types: pdf, jpg, Max. file size: 2 MB, Max. files: 3.

Agreement

1. Terms of Sale are as follows: Net 10th Prox. All invoices are due on or before the 10th of the month following the month of purchase. Past due invoices are subject to a 2% Monthly Service Charge, and if not paid within the following 30 days, may result in a closed account. A charge of 20% will be made for material accepted for return without original billing invoice. 2. We are the principals in the above business and each of us hereby personally and unconditionally guarantees any obligation of the company, both jointly and severally. We agree that we are primarily responsible and that you have the right to sue us in the event this matter is turned over to an attorney for collection, we agree to pay all costs and disbursements of collection, service charges, legal fees calculated at the rate of 1/3 of any amount due, whether or not suit is actually instituted, and any other expense which we incur as a result of attempting to collect. We also agree to the terms of the sale and waive notification of any amendment to the sales agreement. This guarantee is made in order to induce you to do business with the company named above. 3. We authorize the use of Consumer Credit Reports for the purpose of credit evaluations. 4. We understand by submitting this form, we are agreeing to the terms and conditions listed above.

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