Account Application | Action Pet Supply

Sales Representative

Date

Corporate Contacts

Main Contact

Main Contact Name *

Main Contact Phone *

Main Contact Email Address *

Alternate Contact

Alternate Contact Name

Alternate Contact Phone

Alternate Contact Email Address

Officers, Members, Partners, and/or Individuals

Office / Partner / Owner 1

Name *

Title *

Phone *

Email *

Address

Office / Partner / Owner 2

Name

Title

Phone

Address

Office / Partner / Owner 3

Name

Title

Phone

Address

Ordering Contact

Name *

Phone *

Fax

Ordering Email *

Website, if applicable

Select preferred acknowledgement methods *

Phone
Email

Opt in for important email updates? *

Email address for promotions if different than ordering email address

Delivery Information

Ship to Street Address if different than store address

Store Hours *

Receiving Hours (if different)

Is store semi-truck accessible for deliveries? *

Delivery Directions

Special Delivery Requirements

Pallet Jack
Hand Truck
Lift Gate
Stairs
Other

Describe Other

Accounts Payable Information

Accounts Payable Contact(s) *

Phone *

Email *

How would you like to receive invoices *

Mail
Email
Fax

Is a Purchase Order Required? *

Payment Terms: C.O.D.

In consideration for the extension of credit to be given to:

I personally guarantee payment for all materials purchased by the above applicant, even if the applicant is a corporation.

I agree to be bound by the terms and conditions of sale as stated on Action Pet's credit/account application.

I agree to notify you of any significant change in our financial position of ownership date in writing, and understand that, in the event of such notice, personal liability will cease only when acknowledged by our company as receiving such notice.

I understand and agree to pay on past due balances a monthly service charge equal to 1.5% per month (18% per annum) of the outstanding balance principle as liquidated damages. In the event of legal action to collect payment for service or merchandise purchase under this agreement, I agree to pay reasonable attorney's fees, court costs, and other costs of collection, provided that a court of competent jurisdiction makes such an award.

Agreed to by:

Printed Name *

Title

Signature

Date

Preferred Method of Payment

Checkboxes

Check given to driver at time of delivery
Check mailed
CC on file (run the week after delivery)
ACH

Company Information

Corporate Contacts

Main Contact

Alternate Contact

Officers, Members, Partners, and/or Individuals

Office / Partner / Owner 1

Office / Partner / Owner 2

Office / Partner / Owner 3

Ordering Contact

Delivery Information

Accounts Payable Information

Payment Terms: C.O.D.

Preferred Method of Payment