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Credit Application


Inside Sales Contact at City Pipe
Principal Name:   Email:
Principal Name:   Email:
Business Information
Company Legal Name
Company Trade Name
Federal Employer ID
Dunn & Bradstreet #
Telephone Number
Fax Number
Accounts Payable Contact
Email Address REQUIRED
Billing Address
Billing Address Cont.
City
State
Zip Code
Physical Address
Physical Address Cont.
City
State
Zip Code
Business Structure Corporation: Publicly Held
Corporation: Privately Held
General Partnership
Limited Partnership
Sole Proprietorship
Corporate Division or Subsidiary
If Division, Enter Parent Company Data
Business Name
Address
Address Cont.
City
State
Zip Code
Telephone Number
Fax Number
Email address
If Incorporated, Please answer the following
Date Incorporated ,
State Incorporated
Type of Business
In Business Since ,
Current Ownership ,
S.I.C Code
Tax Status Non Exempt
Exempt
Note If exempt, you must submit the Exemption Certificate
State Sales Tax Number
Local Sales Tax Number
Trade References
Reference #1
Business Name
Address
Address Cont.
City
State
Zip Code
Telephone Number
Fax Number
Email address
Reference #2
Business Name
Address
Address Cont.
City
State
Zip Code
Telephone Number
Fax Number
Email address
Reference #3
Business Name
Address
Address Cont.
City
State
Zip Code
Telephone Number
Fax Number
Email address
Reference #4
Business Name
Address
Address Cont.
City
State
Zip Code
Telephone Number
Fax Number
Email address
Bank References
Bank Name
Bank Address
Bank Address Cont.
City
State
Zip Code
Officer Name
Telephone Number
Submitter Information
Submitter Name
Title
Email Address

I authorize the release of the above banking information along with the attached trade references to City Pipe and Supply, Co. for the purpose of establishing a charge account.

Standard terms for materials purchased by customer is due within thirty (30) days after the date of the invoice for that merchandise. Payment should be mailed to City Pipe & Supply corp., P.O. Box 946, Odessa, TX 79760. If payment by check is received by City Pipe & Supply Corp. within ten (10) days after the date of invoice, the customer is entitled to a 1% early payment discount. Due to the cost of processing, credit card payments are not entitled to a cash discount.

I (We) understand the following: that the information furnished to you on this page, is for purpose of obtaining credit from your firm, that I am (we are) authorized, in my (our) capacity to bind my (our) firm accordingly: that all accounts or moneys due shall be due payable at your place of business; that all past due accounts, notes or judgments shall bear interest at the maximum non-usurious interest rate allowed by applicable state or federal law, whichever is greater.

If for any reason moneys owed to City Pipe by us shall not be promptly paid when due, as stated in the payment terms on the invoices, City Pipe may at it sole discretion, demand full payment of all amount owed to City Pipe, and upon such demand being made by City Pipe to debtor in writing, debtor will immediately pay said amount to City Pipe.

In the event of legal action has to be instituted I (we) agree to pay all costs of collection including court costs and reasonable attorney fees. The laws of Texas shall govern in the event legal action is taken.

By submitting this form you agree to the above






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Send this Credit Application to: credit@citypipe.com or fax 432-332-6243.