SLHS Wholesale Customer Information Form

SLHS Wholesale Customer Information Form

New credit accounts are available to wholesale customers purchasing $3,000.00 or more annually. To request a Credit Application, include a note in the Comments Section below.

**PRIVACY ASSURANCE: We only use the details below for our company's internal purposes. We will not pass your Personal Information to marketing companies or any other 3rd party companies.

Fields marked with * are required.

		*Date
*Company Name
Billing Address:
*Address Line
*City
*State
*Zip Code
*Phone
Shipping Address: (if different from Billing Address)
Address Line
City
State
Zip Code
E-Mail
Cell
Fax

Website
*Organization Type (Corporation, Partnership, or Sole Proprietor)
Personnel:
*Owner/Manager	Sales Manager	Secretary
Accounts Payable	Other
*Key Officers and/or Owners
*Number of Employees	*Number of Locations	*Number of Years in Business
*Federal ID No. or SS Number
Exempt Number
Contractor's License Number *Log Contruction? *General Contruction? * Main Products/Services offered by your Company:
Names & Phone numbers of three businesses that know you as a contractor: * 1. Phone * 2. Phone * 3. Phone Comments