Credit Application - Print This page, fill out, and fax to: 770 441-1806         Go Back

Humphries Building Products Inc.

2830 Humphries Way

Peachtree Corners , GA 30360

770-441-9175

Fax: 770-441-1806

Email: Humphriesbuildingproducts@gmail.com

New Customer Credit Application

COMPANY NAME:___________________________________________________________

BILLING ADDRESS:___________________________________________________________

CITY:__________________ STATE:_______________ ZIP CODE:______________________

EMAIL ADDRESS:_______________________________

EMAIL ADDRESS FOR PAPERLESS BILLING:________________________________________

PHONE #:______________________

FAX #:_________________________

PRINCIPALS

NAME:_____________________________ TITLE:_________________________________

NAME:_____________________________ TITLE:_________________________________

A/P CONTACT NAME:________________________________

NUMBER OF YEARS IN BUSINESS:_______________________

TRADE REFERENCES

NAME:________________________ FAX #:________________ ADDRESS:___________________

NAME:________________________ FAX #:________________ ADDRESS:___________________

NAME:________________________ FAX #:________________ ADDRESS:___________________

NAME:________________________ FAX #:________________ ADDRESS:___________________

 

I hereby authorize release of usual and customary credit information requested by Humphries Building Products Inc. for the purposes of credit evaluation.

 

SIGNATURE:__________________________ DATE:______________