Company
Est.
Ph#
Owner(s)/Officer(s)
Fx#
Principals
E-MAIL ADDRESS
Bill To
City, State, Zip
Ship To
City, State, Zip
A/P Ph#
A/P Manager,Contact or Agent
SOLE
PARTNERSHIP
CORPORATION
Incorporated under the laws of the State of
Present Location Since
WEB ADDRESS
OWNERS OR PRINCIPALS MUST COMPLETE THE FOLLOWING PERSONAL INFORMATION FOR OPEN CREDIT WITH IPS.
Home Address
City
State
Zip
SS#
Drivers License
State of Issue
Expiration
Bank Name
Acct#
Ph
Fx
Address
City
State
Zip
By signing this, I authorize my bank to release information to IPS
Digital Signature
Date
Company
Acct#
Ph
Fx
Address
City
State
Zip
Company
Acct#
Ph
Fx
Address
City
State
Zip
Company
Acct#
Ph
Fx
Address
City
State
Zip
In an effort to determine your discount, please answer the following:
Estimated Volume
Frequency of Order
Current Supplier
D&B # & Rating
OUR TERMS ARE NET 30 DAYS, HOW DO YOU TYPICALLY PAY?
Early
31-35
35-40
40-45
45-50
60-90
The undersigned swears that the information provided is true and correct and agrees to IPS Terms and Conditions as outlined in the IPS Parts Catalog and to the following statement: I promise to make all payments promptly, when due, according to the terms of the Sales Invoice. To bear any-and-all expenses including interest charges incurred, if it becomes necessary to file lien or suit or to utilize the services of an attorney or collection agency to handle delinquent account activity. Finance charges of 24% per annum or 2% month will be charged to past due invoices and additional balances.
There will be a service charge of $100.00 for each invoice turned over to collections.
Officer / Owner Digital Signature
Date
Title
PLEASE DIGITALLY SIGN, DATE AND SUBMITOUR FORM.
SERVICE IS IMPORTANT TO US, WE WILL PROCESS COMPLETE APPLICATIONS IMMEDIATELY,
TERMS ESTABLISHED IN 1 DAY OR LESS.
ONCE YOU SUBMIT THIS FORM, YOU WILL BE ASKED TO CREATE A NEW IPS WEB ACCOUNT.
