Credit Application If you would rather print this Credit Application and mail it to us, click here. NON-PROFITS TAKE NOTEYou must submit a copy of your Ohio Tax Exempt form by USPS, fax, or seperate email before this application can be processed. office@phillipscompanies.com || FAX: 937-426-0659 || Blank tax form here. Section ACompany Information Company Name Owner / President Name Date Inc. How Long in Business Is this, or Are you a -- select -- Corporation Partnership Individual Non-Profit Other Are You Tax Exempt? Yes No Upload your Ohio Tax Exempt form: Fed I.D. or SSN/Lic # Type of repayment: COD - cash on demand Account - weekly billing, net 30 days Section BContact Information Physical Address Mailing Address City, State & Zip Phone Number Fax Number Email Address Section COwnership Information PRIMARY OWNER Name Title SSN: Address City State Zip Phone Number Add another owner OWNER #2 Name Title SSN: Address City State Zip Phone Number If you have more owners to report, complete and submit this form then contact Phillips Companies directly. Section DBank Reference Bank Name Account # Address City State Zip Contact Person Phone Number Section ESupplier Reference Three (3) Supplier References must be provided. Five (5) are allowed on this form. If you need to submit more, complete this form, submit it, then contact Phillips Companies Directly. SUPPLIER Supplier Name Address City State Zip Phone Number Fax SUPPLIER #2 Supplier Name Address City State Zip Phone Number Fax SUPPLIER #3 Supplier Name Address City State Zip Phone Number Fax Add another supplier SUPPLIER #4 Supplier Name Address City State Zip Phone Number Fax Add another supplier SUPPLIER #5 Supplier Name Address City State Zip Phone Number Fax If you have more suppliers to report, complete and submit this form then contact Phillips Companies directly. 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. DO YOU AGREE?Yes No 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. Please enable JavaScript for this form to work.
