APPLICANT BUSINESS INFORMATION

Name of Business
Street Address
City State Zip Code
Mailing Address
City State Zip Code
Office Phone # Fax #
Mobile # Home #
Years In Business HVAC # CFC #
Fed ID # Corp, state incorporated
Corporation Type Sole Proprietorship   Partnership   LLC   Corporation
E-Mail Address
How did you hear about us? Your Company's Yearly Sales Volume
Anticipated Northeastern Monthly Purchases Total Estimated Monthly Purchases
Are your financial records available for the last two accounting periods ? Yes   No If yes, you will be prompted to upload documentation
during application submission.		  

REFERENCES/PRIMARY SUPPLIERS

1 Name Average Monthly Purchase Account #
Address Phone # Fax #
 
2 Name Average Monthly Purchase Account #
Address Phone # Fax #
 
3 Name Average Monthly Purchase Account #
Address Phone # Fax #

BANKING INFORMATION

Bank Name Account #
Address Phone #
Surety company used on jobs requiring bonds Phone #

PRINCIPAL OWNER(S) OR OFFICER(S):

  Name Title Resident Address Resident Phone Social Security #  
1  
Add Another Owner or Officer

PLEASE CHECK THE SIC CODE BOX(S) THAT APPLY TO YOUR BUSINESS

1711-0000 Plumbing, heating, air-conditioning 1711-0400 Heating and air conditioning contractor 7699-0300 Boiler and heating repair services
1711-0100 Boiler and furnace contractor 1711-0401 Mechanical contractor 5074-0000 Supply House
1711-0101 Boiler maintenance contractor 1711-0402 Process piping contractor 6500-0000 Apartment / Real Estate
1711-0102 Boiler setting contractor 1711-0403 Solar energy contractor 5251-0000 Hardware Store
1711-0103 Heating systems repair and maintenance 1711-0404 Ventilation and duck work contractor 1623-0000 Utility / Excavating Contractor
1711-0104 Hydronics heating contractor 1711-0405 Warm air heating & air conditioning contractor 1700-0000 Kitchen / Bath Dealer
1711-0200 Plumbing contractor 1711-9901 Refrigeration contractor 1500-0000 Builder
1711-0201 Septic system construction 1781-0000 Water well drilling 1711-9900 Water Conditioning
1711-0300 Sprinkler contractor 1781-9901 Geothermal drilling 2039-0000 Industrial User
1711-0301 Fire sprinkler system installation 1781-9902 Servicing, water wells Other
1711-0302 Irrigation sprinkler system installation  

ADDITIONAL INFORMATION

Were any of the principals in business before? Yes   No If yes, give name of business and reason for discontinuing:
Your Purchasing Agent (or person you’d like us to contact regarding sales)
Your Purchasing Agent E-Mail Address
Accounts Payable Clerk (or person you’d like us to contact regarding payment)
Accounts Payable Clerk E-Mail Address
Work From Home Shop P.O Required ? Yes No Job Name Required ? Yes No
Tax Exempt ? Yes No If yes, you will be prompted to upload documentation during application submission.
# of employees Number of invoices required ?
Receive Invoices via E-Mail Yes No
Name E-Mail Address

Other Special Billing Instructions

LEGAL INFORMATION

I/we the undersigned, agree to pay all sums due Northeastern Supply Inc. (hereinafter “N/E”) according to the terms stated on N/E invoices, said terms being incorporated by reference herein and made apart hereof, and Purchaser further agrees to pay 2% per month service charge on all amounts not paid within thirty (30) days from the twenty-fifth (25) day of the month in which the items were originally billed, minimum service charge $2.50. Purchaser agrees that returned materials may be subject to a restocking charge. Purchaser will pay, in addition to the amount due on the account, attorney’s fees of thirty-three and one third percent (33 1/3%) of the amount due on the account at the time the account is turned over to an attorney or collection agency for collection, as well as all other incidental costs of collection, and further agrees that N/E shall have the right to choose at its option the jurisdiction and venue wherein to bring any legal proceeding to enforce any term or condition of the agreement between Purchaser and N/E and waives any and all objections to the jurisdiction and venue so chosen. The law of the jurisdiction so chosen shall be applicable law in any litigation brought hereunder. Should any part of this Agreement be found to be invalid or unenforceable the remaining portions shall remain in full force and effect.

The undersigned certifies the information given on this application to be correct and that it is submitted for the purpose of obtaining credit, and authorizes you to inquire of creditors, banks, and other references and allow you to answer questions from others about your credit experience with us.

For and in consideration of Northeastern Supply Inc., (hereinafter “N/E”) extending credit at the request of the Purchaser, the Undersigned personally guarantee(s) to N/E the payment of any obligation of the Purchaser, its successors and assigns, and the Undersigned hereby agrees to pay N/E on demand without offset, any sum which may become due to N/E by the Purchaser whenever the Purchaser shall fail to pay the same, and further agree(s) to pay N/E attorney’s fees of thirty-three and one third percent (33 1/3%) of the amount due on the account at the time the account is turned over to an attorney or collection agency for collection, as well as all other incidental costs of collection, and further agree(s) that N/E shall have the right to choose, at its option, the jurisdiction and venue wherein to bring any legal proceeding to enforce any term or condition of the agreement between N/E and the Undersigned and waive(s) any and all objections to the jurisdiction and venue so chosen. The law of the jurisdiction so chosen shall be the applicable law in any litigation brought hereunder. Should any part of this Agreement be found to be invalid or unenforceable, the remaining portions shall remain in full force and effect. This guarantee shall remain in effect until all outstanding balances, including finance charges, late fees, attorney’s fees, or any other charges have been paid in full. The incorporation, merger, reorganization, dissolution, insolvency, sale or any other change in status of the Purchaser shall not operate as a termination of this Guarantee and it shall continue to be effective for any credit extended by N/E to any successor, assign, or other related entity of Purchaser. To the extent permitted by law, the Undersigned hereby agree(s) to waive any Homestead exemption to which they might otherwise be entitled, notice of acceptance hereof, notice of presentment, demand, non-payment, dishonor and protest, and consent(s) to and waive(s) notice of any modification, amendment or extension of the terms of the credit agreement hereby guaranteed.

The Undersigned authorizes N/E to investigate the credit and financial responsibility of the Undersigned in an effort to evaluate credit worthiness prior to granting credit to the Purchaser and periodically thereafter until the Purchaser’s account is paid in full and closed.

It is understood that this Guarantee is given without prejudice to any other collateral, right or security which N/E has or may obtain, including rights under a bond or bonds, or mechanic’s liens. The undersigned agree(s) and consent(s) that facsimile signatures shall be deemed original signatures for all purposes in connection herewith.

Digital Signature

The persons signing this application certify that they have the authority to do so, and that all information contained herein, and in any attachment or amendment is true, correct and complete, to the best of their knowledge and belief. To digitally sign this credit application please type your full legal name into the "Signature" textbox as well as the "Print Name" textbox. Please also provide your SS#.

1 Signature SS # Print Name

By clicking "SUBMIT APPLICATION" the undersigned acknowledges and agrees that Creditor may utilize outside reporting services to obtain information on the undersigned. In the event that the undersigned is/are individual(s), the signing of this agreement shall constitute authorization to Creditor to utilize consumer credit reporting agencies to provide reports on said individual(s) in order to permit Creditor to appropriately evaluate the extension of any business credit. Additionally, should any individual(s) guarantee the debt of the undersigned, said individual(s) shall be provided with a copy of this Credit Application, and upon the signing of said guaranty, shall consent to Creditor's use of consumer credit reporting agencies' reports to assist in the evaluation of the credit of said guarantor(s).