Credit Application and New Account Information Form

Company Name
Billing Address
Billing City
Billing State
Billing ZIP Code
Shipping Address
Shipping City
Shipping State
Shipping ZIP Code
Business Entity Type:
If Incorporated, in which state?
FIN or Sales Tax #
How long have you been in business?
Business Description
Owner Officers
(include name-title)
Buyer Contact Person
Contact Email Address
Contact Phone with Ext. Number


I hereby certify: that the above named company holds limited Sales Tax Permit Number, noted below, issued pursuant to the Limited Sales, Excise and Use Tax Law, and that the tangible personal property described below, or which is shown in the attached order of invoice which is made a part hereof, which I will purchase from TEXAS SPECIALTIES, will be resold, rented or leased by me in the form of tangible personal property, however, if  I make any use of the tangible personal property other than retention, demonstration or display while holding it for sale, lease or rental in the regular course of business, the use shall be taxable to me as of the time when the tangible personal property is first so used, and the sales price of the tangible property to me shall be seemed the measure of the tax.

Description of the property to be purchased
Sales Tax Resale Certificate Number
Issuing State
Complete this section if applying for C.O.D. or payent with Credit Card.
MC, AMEX, VISA (Circle one) #
Credit Card #
Exp. Date
Complete this section if applying for Open Credit.
Include : Company Name, City, State, Phone Number, Fax Number, Contact
Trade Reference 1
Trade Reference 2
Trade Reference 3
Trade Reference 4
Check here if COD or Credit Card is acceptible until open credit is approved?

I certify that all the information on this form is correct and authorize TEXAS SPECIALTIES to obtain a written or oral report from any credit reporting agency, applicant further authorizes any commercial business to give any and all necessary information to the creditor which will assist creditor in the investigation.  If credit is extended, I agree to pay all debts incurred within the terms of sale.  Should the debt become past due, I expressly agree to pay a service fee at the rate of 18% per annum.  Any service fee charge not paid when due shall be subject to additional service fees.  I further expressly agree to pay reasonable collection costs and/or attorney fees incurred in connection with the collection of this account.  There will be a return check fee of $25.00

Applicant's Name

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