Apply For Credit at Bruco

Apply for Credit at Bruco

Credit Application
Must Be Filled Out Completely Before Credit Can Be Approved

Date:
______________________________________________________________

Business / Corp./ Individual Name:

Mailing Address:
City: State: Zip:

Shipping Address
(if different)
City: State: Zip:

Phone # : Fax # :

Owner / Contact Person:

Years in Business: Type of Business:

Federal Tax ID # :
______________________________________________________________

Credit References

Name:

Address:
City: State: Zip:

Phone # : Fax # :
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Name:

Address:
City: State: Zip:

Phone # : Fax # :
______________________________________________________________

Other Information

Estimated monthly purchases $:

Do you require a purchase order? yes | no

List of individuals authorized to sign on this open account:

Please read and agree to the terms on the left before submitting.
I agree to the terms

PLEASE READ CAREFULLY

You are applying for NET 15 DAY credit. The amount must be kept current at all times or credit privileges will be subject to review. Account may automatically revert to CASH ON DELIVERY status without notice whenever overdue. We reserve the right to discontinue sales or services to past due accounts and claim any labor or material liens provided by law. DEFAULT OF THIS CREDIT AGREEMENT WILL RESULT IN COLLECTION ACTION AT WHICH TIME THE APPLICANT WILL BE RESPONSIBLE FOR ANY AND ALL COLLECTION FEES PLUS LEGAS FEES.