Credit Application - Print This page, fill out, and fax to: 770 441-1806 Go Back
Humphries Building Products Inc.
2830 Humphries Way
Doraville, GA 30360
770-441-9175
Fax: 770-441-1806
Email: Humphriesbuildingproducts@gmail.com
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:______________