2019-2020 Purchasing Guide Volume 6

FORMS & REFERENCE

CREDIT APPLICATION Fax: 866.634.6747 Credit Phone: 281.983.6300 CREDIT APPLICATION Fax: 866.634.6747 Credit Phone: 281.983.6300

Email: creditApp@supplyHQ.com Email: creditApp@supplyHQ.com

TRADE NAME: TRADE NAME:

Number of Units: Number of Units: Fee Managed Only Fee Managed Only

PHONE: PHONE: PHONE: PHONE:

MANAGEMENT COMPANY/OWNER NAME: MANAGEMENT COMPANY/OWNER NAME:

LEGAL ENTITY NAME: LEGAL ENTITY NAME:

FAX: FAX:

PLEASE SELECT ONE: PLEASE SELECT ONE:

OWNER OWNER

MANAGER BOTH MANAGER BOTH

COURT APPOINTED TRUSTEE COURT APPOINTED TRUSTEE

OTHER __________________________________ OTHER __________________________________

PUBLICLY TRADED (Symbol: _________) PUBLICLY TRADED (Symbol: _________)

CORPORATION PARTNERSHIP OTHER __________________________ CORPORATION PARTNERSHIP OTHER __________________________

REIT: REIT:

YES YES

NO NO

COUNTY: COUNTY:

FEIN: FEIN:

DATE OF ACQUISITION: DATE OF ACQUISITION:

SALES TAX EXEMPT: (circle) Y N If “Y”, valid tax exempt form must be attached. SALES TAX EXEMPT: (circle) Y N If “Y”, valid tax exempt form must be attached.

DELIVERY ADDRESS: DELIVERY ADDRESS:

CITY: CITY: CITY: CITY:

STATE: STATE: STATE: STATE:

ZIP: ZIP: ZIP: ZIP:

BILLING ADDRESS (if different from above): BILLING ADDRESS (if different from above):

NAME OF PRIMARY CONTACT: NAME OF PRIMARY CONTACT:

TITLE: TITLE:

PHONE: PHONE:

FAX NUMBER: FAX NUMBER:

PRIMARY CONTACT EMAIL ADDRESS: PRIMARY CONTACT EMAIL ADDRESS:

CONTACTS CONTACTS

A/P CONTACT: A/P CONTACT:

EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS:

PHONE: PHONE: PHONE: PHONE: PHONE: PHONE:

FAX: FAX: FAX: FAX: FAX: FAX:

COMMUNITY ADDS/DELETES: COMMUNITY ADDS/DELETES:

TECHNOLOGY SUPPORT: TECHNOLOGY SUPPORT:

ACCOUNT DETAILS ACCOUNT DETAILS

ORGANIZATION NAME: ORGANIZATION NAME:

IDENTIFIER OR ID#: IDENTIFIER OR ID#:

GPO Membership: GPO Membership:

Yes No Yes No

PO Number required: Yes PO Number required: Yes

No No

Vendor Agreement required: Vendor Agreement required:

Yes Yes

No If, “Yes”, please forward via email to: creditApp@supplyHQ.com No If, “Yes”, please forward via email to: creditApp@supplyHQ.com

Alternate preferred payment options: Alternate preferred payment options: Invoice/Statement Email Option: If preferred method of delivery, please provid valid mail addr ss. Invoice/Statement Email Option: If preferred method of delivery, please provide valid email address.

3 rd Party Processor (if so, please identify: 3 rd Party Processor (if so, please identify:

Credit Card ACH/Electronic Transfer Credit Card ACH/Electronic Transfer

) )

EMAIL ADDRESS: EMAIL ADDRESS:

The undersigned certifies the above information to be true and correct, that it is submitted for the purpose of obtaining credit and agrees to the Terms and Conditions of Sale of Seller on reverse side and any changes to those terms, which may occur in the future; and further acknowledges and agrees that applicant is authorized to bind itself and its principal in accordance with the terms herewith; all of which are herein incorporated by reference. The undersigned further authorizes Seller to request and receive credit reports from credit bureaus and other credit service organizations for the purpose of investigating the Purchaser’s business and its eligibility for commercial credit. The undersigned consents to an investigation into the creditworthiness of the Purchaser. Signature ___________________________________________________ Title_____________________________________________________ Printed Name__________________________________________________ Date____________________________________________________ The undersigned, to induce the granting of credit to the above-named firm, hereby PERSONALLY GUARANTEES all indebtedness hereunder. This Guaranty is a guaranty of payment and not of collection, and Seller may enforce this Guaranty and seek payment from the undersigned guarantor, and guarantor will pay the amounts under this guaranty, irrespective of collections efforts, if any, against, the above-named firm. I further agree that this guaranty is an absolute, completed and continuing one and no notice of this indebtedness or any extension of credit already or hereafter contracted by or extended need be given. The terms may be re-arranged, extended and/or renewed without notice to me. That I will, within five (5) days from date of notice that the account is past due, pay the amount due. I hereby authorize the Seller to investigate the information provided pertaining to my credit and financial responsibility. The undersigned certifies the above information to be true and correct, that it is submitted for the purpose of obtaining credit and agrees to the Terms and Conditions of Sale of Seller on revers sid and ny changes to those t rms, which may occur in the futur ; and further ackn wledges and agrees that applicant is authorized to bind itself and its principal in accordance with the terms herewith; all of which are herein incorporated by referenc . The undersigned furth r authorizes Seller to request and receive credit reports from credit bureaus and other credit service rganizations for the pur se of investigating the P rcha er’s business and its eligibility for commercial credit. The undersigned consents to an investigation into the creditworthiness of the Purchaser. Signature ___________________________________________________ Title_____________________________________________________ Printed Name__________________________________________________ Date____________________________________________________ The undersigned, to induce the granting of credit to the above-named firm, hereby PERSONALLY GUARANTEES all indebtedness hereunder. This Guaranty is a guaranty of payment and not of collection, and Seller may enforce this Guaranty and seek payment from the undersigned guarantor, and guarantor will pay the amounts under this gu ranty, irresp ctive of colle tions efforts, if any, against, the above-named firm. I further agree that this guaranty is an abs lute, completed and continuing one and no notice of this indebtedn ss or any extension of credit alre dy or reafter contracted by or extended need be given. The terms may b re-arrang , extended and/or r newed without notice to me. That I will, within five (5) days from d te f notice that the count is past due, pay the amou t due. I hereby authorize the Seller to investigate th information provided pertaining to my credit and financial responsibility. Signature ___________________________________________________________________________________________________________ Printed Name___________________________________________________________Date__________________________________________________ PERSONAL GUARANTY FOR OFFICE USE ONLY: SALES REP ID: WHSE: ROUTE: ACCOUNT #: Signature ___________________________________________________________________________________________________________ Printed Name___________________________________________________________Date__________________________________________________ PERSONAL GUARANTY FOR OFFICE USE ONLY: SALES REP ID: WHSE: ROUTE: ACCOUNT #: *If credit line requested exceeds $10,000 – Please attach a copy of purchaser’s most recent financial statement. *If credit line requested exceeds $10,000 – Please attach a copy of purchaser’s most recent financial statement.

MSH Remittance Address: Maintenance Supply Headquarters, P.O. Box 301451, Dallas, Texas 75303-1451 MSH Remittance Address: Maintenance Supply Headquarters, P.O. Box 301451, Dallas, Texas 75303-1451

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