CREDIT APPLICATION, GUARANTY & MASTER SALES AGREEMENTCredit Application, Guaranty & Master Sales Agreement • November 18th, 2016
Plumbing / HVAC WaterworksFire & Fabrication New Applicant Update Mail: 10355 S ORANGE AVE STE B Fax: 407-856-9731 Primary location of material purchases (required):# ORLANDO FL 32824 City Bushnell State FL A. APPLICANT (BUSINESS NAME OR NAME OF INDIVIDUAL IF SOLE PROPRIETOR) Name Sumter County Board of County Commissioners Phone 352-689-4400 Street Address 7375 Powell Rd Fax 352-689-4401 City Wildwood State FL Zip 34785 Mobile/Pager Email Mark if Yes Yes Please send Applicant special offers and updates via email.Yes Checks received may be converted to an electronic funds transfer without further notice. Yes Please enroll Applicant in Ferguson Online to allow access to the account via the internet. B. PRINCIPALS/OFFICERS Title Name City/State Social Security # Birth date Phone Insolvency* Chairman Don Burgess Wildwood / FL 352-689-4400 / / / * List the year of any bankruptcy or insolvency by principal/officer or any affiliated corporation, LLC,
CREDIT APPLICATION, GUARANTY & MASTER SALES AGREEMENTCredit Application, Guaranty & Master Sales Agreement • June 22nd, 2012
Plumbing / HVAC Waterworks Fire & Fabrication New Applicant Update Mail: Attn: Credit Dept.Fax: 818.649.1645 514 Riverdale Dr.Glendale, CA 91204 A. APPLICANT (BUSINESS NAME OR NAME OF INDIVIDUAL IF SOLE PROPRIETOR) Name Phone Street Address Fax City State Zip Mobile/Pager Email Mark if Yes Yes Please send Applicant special offers and updates via email. B. PRINCIPALS/OFFICERS Title Name City/State Social Security # Birth date Phone Insolvency* / / / / * List the year of any bankruptcy or insolvency by principal/officer or any affiliated corporation, LLC, partnership or business. C. BILLING INFORMATION Billing Address (if different from above) Are Purchase Orders Issued? Yes City State Zip Are job names required? Yes Sales Tax Exemption # State PLEASE ATTACH AN EXEMPTION CERTIFCATE FOR CALIFORNIA Special Billing Instructions Federal Tax ID#/Employer ID# D. ABOUT YOUR COMPANY (ATTACHED FINANCIAL STATEMENTS FOR THE LAST TWO YEAR
CREDIT APPLICATION, GUARANTY & MASTER SALES AGREEMENTCredit Application, Guaranty & Master Sales Agreement • September 16th, 2019
CREDIT APPLICATION, GUARANTY & MASTER SALES AGREEMENTCredit Application, Guaranty & Master Sales Agreement • November 15th, 2016 • Carolina
(CIRCLE ONE) INDIVIDUAL SOLE PROPRIETOR PARTNERSHIP CORPORATION LLC LLP FULL COMPANY NAME - OR INDIVIDUAL NAME - OR CUSTOMER NAME FAX NO. ADDRESS - STREET NO. and STREET NAME CITY STATE ZIP PHONE FEDERAL I.D.# E-MAIL ADDRESS HOW LONG IN BUSINESS UNDER CURRENT NAME( ) YEARS MONTHS INITIAL JOB LOCATION (House No., Street Name & City or Lot No., Subdivision Name & City) COMPANY / INDIVIDUAL BANK ACCOUNT WITH: LOAN OFFICER / BANKER NAME ACCOUNT NUMBER PHONE NUMBER: CONTRACTORS LICENSE NUMBER DRIVERS LICENSE NUMBER AUTHORIZED CHARGERS P.O. REQUIRED? Yes No
