Confidential Credit Application

Please check the branch you wish your account invoiced from:
CLEVELAND
10311 Berea Road
Cleveland, OH 44102
Phone: 216.651.1900
Fax: 216.651.1906		 ASHLAND
1245 Middle Rowsburg
Ashland, OH 44805
Phone: 419.281.4577
Fax: 419.281.2089

CANTON
1705 Shepler Church Avenue SW.
Canton, OH 44706
Phone: 330.452.6565
Fax: 330.452.5387

 MANSFIELD
294 East Third Street
Mansfield, OH 44902
Phone: 419.522.0417
Fax: 419.522.4435
LORAIN
915 Colorado Avenue
Lorain, OH 44052
Phone: 440.288.9143
Fax: 440.288.5012		 NEW PHILADELPHIA
221 Ray Avenue, N.E.
New Philadelphia, OH 44663
Phone: 330.343.5571
Fax: 330.364.5099
Terms of sale as follows: All invoices are due on or before the tenth of the month following the month of purchase. Any invoice not paid by the end of the month is subject to a 2% service charge and if not paid within the following 30 days, could result in a closed account.
Company Name  
Phone #
County  
Address
City and State
 Zip
Type of Business:
*If A Partnership or Proprietorship - Names and Addresses of Principals
Name
 Wife's  Address
Address
Name
 Wife's  Address
Address
Type of Business
Established
Year
Approx. Worth of Co.
 Initial  Credit  Request
**If Corporation - Officers' Names and Addresses
Name Title
Address
Name Title
Address
Name Title
Address
FINANCIALS
Name of Your Bank
Complete Address

Phone Number
Value of Real Estate Owned
Type of Real Estate
Title of Real Estate in Name of
Mortgage Held by
Amount
Value of Tools, Trucks and Equipment
Mortgage
Net Sales Past Year
Net Profit (loss) for the Year
Ohio Sales Tax Status If Exempt, please attach certificate.
TRADE REFERENCES - If new business, give names and addresses of former employers and personal credit references.
1. Name
1. Complete Address
1. Phone Number

 
2. Name
2. Complete Address
2. Phone Number

 
3. Name
3. Complete Address
3. Phone Number

To the best of my knowledge and belief, the above statements are true and correct. In consideration of the sale of material to the above named corporation or company, I personally as an individual, guarantee payment of all purchases made on behalf of the above named corporation or company. I also certify that I am a principal in the above business and personally guarantee this Account Application hereby authorizes The Rex Pipe and Supply Company or any of its affiliated corporations, the right to investigate the credit of the Applicant with any of its suppliers, financial institutions, credit bureaus, or credit reporting agencies.

Signature ____________________________________________________

Home Address _______________________________________________

Phone No. ___________________________________________________

Date________________________________________________________

For Office Use Only:
Credit on this account:       is Approved        is NOT Approved
Salesman No.______________________________________________
Business Type______________________________________________
Branch No._________________________________________________
Credit Limit_________________________________________________
Open Account Starting________________________________________
Sales Tax Exemption Certificate on hand and correct.      Yes

Authorized by _______________________________________________


  


Please mail your completed Credit Application to:
Rex Pipe and Supply Company
c/o Credit Department
10311 Berea Road
Cleveland, OH 44102