Company Name:                    

Street (Delivery) Address:

City:   State: Zip Code:

Billing Address:  (Check here if same as above)

Street Address or PO Box:

City:   State:   Zip Code:

Primary Type of Business: Retail Wholesale Manufacturer Distributor Dealership Detailier Janitorial Other     Primary Field: Marine Automotive RV Motorcycles PWCs Industrial Residential

If "other", please explain:

Were you referred to this site by a Dealer or Sales Rep? Yes No If yes, by whom?

What type of account are you applying for?             

Commercial        Wholesale       

In what state(s) are you licensed to do business?

EIN:     Resale Tax ID: (Copy of certificate required)

Type of Business:    Corporation    Partnership    Sole Proprietorship

If a corporation, in what State(s) are you incorporated?

Purchasing Contact: Phone:

Billing Contact: Phone:

Website:

Trade References:                                                                                                                                                                                   

Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

Bank and Financing Companies References:                                                                                                                                           

Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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Busines

Business Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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s Name:

Address:

City:  State:   Zip: Acct#

Contact:Phone:  Fax:

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Upon the approval of credit, we agree to pay according to Hammerhead Cleaning Frenzy’s terms of sale, with checks to be mailed to the address shown on invoice.  The terms and conditions of sale are stated on the order acknowledgement.  The undersigned company agrees to pay, in the event the account becomes delinquent and turned over to an attorney, reasonable attorney fees and court costs. 

I hereby submit this information to use as a basis for extension of credit.  I authorize Hammerhead Cleaning Frenzy! to contact the above mentioned references for the purposes of establishing credit.

Electronic signature:                                                                                                                                                                                    

Authorized By (Owner, Partner, Corporate Officer):

Title:Date:

Comments, notes, or special requests:

Or:  Click this link to open and print Application in .pdf format.  If you do not have Adobe, click link for free download.

Wholesale Account Application (Purchase for resale)

Commercial Account Application (Purchase for use - not for resale)