Company's Legal Name *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip *

Shipping Address *

Shipping City *

Shipping State *

Shipping Zip *

Contact Info

Phone *

Fax

Email *

Are you required to pay sales tax? *

Tax Exempt # *

INCLUDE COPY OF EXEMPTION CERTIFICATE TO BE CONSIDERED TAX EXEMPT

Tax Exempt Certificate

Date company acquired *

Type of Business *

Number of years in business *

Owner Info:

Owner's Name *

Owner's Address *

Owner's City *

Owner's State *

Owner's Zip *

Partner or Spouse Info:

Partner/Spouse Name

Partner/Spouse Address

Partner/Spouse City

Partner/Spouse State

Partner/Spouse Zip

Trade References: Charge Accounts Only - Full name, Fax, or Email Addresses

Trade Reference 1

Trade Reference Name 1 *

Trade Reference Phone 1 *

Trade Reference Email 1 *

Trade Reference 2

Trade Reference Name 2 *

Trade Reference Phone 2 *

Trade Reference Email 2 *

Trade Reference 3

Trade Reference Name 3 *

Trade Reference Phone 3 *

Trade Reference Email 3 *

The undersigned hereby agrees to abide by the selling terms of American Copper & Brass, LLC. (1%30, NET 45 days from the date of the invoice. Late payments will be charged a 1.5% late fee (min $5.00) starting the 46th day. (18% per annum).).

Applicant consents to jurisdiction and venue in Coldwater, MI and agrees to pay any collection costs incurred to collect the account balance, including reasonable attorney’s fees.

The undersigned warrants that the information submitted is true and correct. American Copper & Brass, LLC is authorized to contact the credit references listed above.

Signature #1

Sign Name/Title 1 *

Sign Date 1 *

Signature #2

Sign Name/Title 2

Sign Date 2

Dear {{name}},

Thank you for filling out our application for credit. We will be in touch soon with next steps

Thanks,

American Copper & Brass

Dear {{name}},

Thank you for filling out our application for credit. We will be in touch soon with next steps

Thanks,

American Copper & Brass

Application for Credit

Contact Info

Owner Info:

Partner or Spouse Info:

Trade References: Charge Accounts Only - Full name, Fax, or Email Addresses

Trade Reference 1

Trade Reference 2

Trade Reference 3

Signature #1

Signature #2

Dear {{name}},

Dear {{name}},

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