DATE*

SALES REP (if applicable):

LEGAL NAME*

DBA*

BILLING ADDRESS*

CITY*

STATE:*

COUNTRY:*

ZIP CODE*

INSIDE CITY LIMITS:*

SHIP TO ADDRESS (IF DIFFERENT FROM ABOVE):

TELEPHONE#:*

CONTACT:*

CELL#:*

EMAIL:*

CHECK ONE:*

YEARS IN BUSINESS:*

FULL NAME OF THE OWNER/OFFICER:*

BANK REFERENCE:*

PHONE#:*

FEDERAL ID#:*

TYPE OF BUSINESS:*

HAS THE FIRM OR PRINCIPLES EVER DECLARED BANKRUPTCY?:*



P.O. # REQUIRED:*



IF NO PO IS REQUIRED, WHAT IS YOUR AUTHORIZATION PROCESS:

LICENSE #:*

Upload copy of license*

TAXABLE:*



IF NO, PLEASE ATTACH TAX EXEMPTION/RESALE CERTIFICATE

EVEN IF TAXABLE, PLEASE PROVIDE W-9 OR FED TAX ID NUMBER:*

PLEASE ATTACH W-9 FORM.*

BUSINESS PROFILE

BRANDS SOLD % SUPPLIER NAME ANNUAL PURCHASES

Annual Gross Sales $*

No. of Svc Techs:*

Service Area:*

% Residential Replacement *

% Residential Service*

% Residential New Construction*

% Commercial Service*

% Light Commercial*

% Service Contractors*

SIGNATURE:*

TITLE:*

PRINT NAME:

------- For COD Account, Stop Here. For Open Credit, Complete Next Section -------

TRADE REFERENCES. THREE REFRENCES ARE REQUIRED:

CREDIT LINE REQUESTED:*

NAME - 1:*

EMAIL ADDRESS - 1:*

NAME - 2:*

EMAIL ADDRESS - 2:*

NAME - 3:*

EMAIL ADDRESS - 3:*

SIGNATURE REQUIRED BEFORE APPLICATION CAN BE APPROVED

SIGNATURE:

TITLE:

PRINT NAME:

Applicant’s signature attests financial responsibility, ability, and willingness to pay invoices in accordance with terms billed. Late charges of 1.5% per month may be assessed to any past due amount. Applicant agrees to standard terms and conditions (pg. 2.) of this application

INDIVIDUAL PERSONAL GUARANTY

I,,Social Security Number, , and (spouse), Social Security Number , Residing at , For and in consideration of your extending credit to (hereinafter referred to as Purchaser), hereby personally guarantee to you the payment at Hunton Distribution Group, 10555 Westpark Dr, Houston, TX 77042, any obligation of the Purchaser and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Purchaser whenever the Purchaser shall fail to pay same. It is understood that this guaranty shall be continuing and irrevocable and will provide indemnity for such indebtedness of the Purchaser. I do hereby waive notice of default and notice of non-payment thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. This guaranty binds the Guarantor, his/her heirs, successors and assigns. In the event there is any change in ownership of the Purchaser, I will immediately notify Hunton Distribution of such change and this guaranty shall also apply to any subsequent owner or owners.

Signature

Signature (spouse)

Witness

Address of Witness

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