Please Complete This Form to Submit a

Credit Application

If you would rather print this Credit Application and mail it to us, please use the pdf version below.

Print PDF Version


You must submit a copy of your Ohio Tax Exempt form by USPS, fax, or seperate email before this application can be processed.

Section A - Company Information
Section B - Contact Information
Section C - Ownership Information
Section D - Bank Reference
Section E - Supplier Reference

Three (3) Supplier References must be provided. If you need to submit more, complete this form, submit it, then contact Phillips Companies Directly.

Supplier #1

Supplier #2

Supplier #3
Read Agreement

By signing this application, I agree to pay all charges within 30 days of invoice date or at time of delivery for cash accounts, unless previous agreements have been made. I understand that all unpaid balances will be charged 2% per month service charges until paid in full. Furthermore, I give The Phillips Companies and it’s agents permission to use whatever means necessary to investigate my credit history, both personal and business (for AR accounts only). I also agree to have all tax exempt certificates submitted to Phillips prior to material delivery or services rendered.

When you click the "Send" button you will be sending all the information from this page in an email to Phillips Companies. If your information is acceptable, an associate will contact you as soon as possible.