Golf Course Management Landscape Nursery Pest Control/Fumigation Vegetation Management

Credit Application and Account Agreement


Please submit the requested information in the web form below. For your protection no social security is required and an electronic signature is accepted.
Click here to download PDF Version
You may attach a reference sheet below.
 Firm Name: (complete legal name) 
 DBA: 
 Business Address: 
 Billing Address:  
 City:   State:   Zip: 
 E-Mail:   Phone:   Fax: 
 When Established: 
 Type of Business: 
 How Long At Above Address: 
 Federal Taxpayer ID: 
 Name of Person Responsible for Purchasing: 
 Requested Line of Credit: 
 Accounts Payable Contact: 
 Resale #:   Business License #: 
 Type: 

 

TYPE OF OWNERSHIP

 SOLE PROPRIETORSHIP


 Name of Owner:

 Home Address:

 City:

 State:   Zip: 

 CORPORATION

 State:    Date: 

 President:

 Vice-President:

 Secretary/Treasurer:

 

PARTNERSHIP

 Name of Partner:

 Home Address:

 City:

 State:   Zip: 

 Name of Partner:

 Home Address:

 City:

 State:   Zip: 

 
CREDIT REFERENCE SHEET IS ACCEPTABLE (attach below)
TRADE REFERENCES FROM WHOM YOU ARE CURRENTLY PURCHASING

 

 Name:   Customer Acct. #: 

 Address: 

 City:   State:   Zip: 

 Telephone:   Fax: 


 Name:   Customer Acct. #: 

 Address: 

 City:   State:   Zip: 

 Telephone:   Fax: 


 Name:   Customer Acct. #: 

 Address: 

 City:   State:   Zip: 

 Telephone:   Fax: 

Reference Sheet: 
 
BANK INFORMATION

 Bank: 

 Branch 

 Bank Address: 

 City:   State:   Zip: 

 Account Number: 

 Business Contact: 

 Telephone:  Fax: 

 I understand and agree to Target Specialty Products’ terms of sale.

 I also understand a service charge of 1 1/2% per month or 18% per annum on past due invoices. Payment terms will be stated on each invoice.

 Checking this box authorizes TSP to use the information provided for credit verification and will be kept confidential for internal use only.
 

License Number Required To Establish Account

Please send copy of license along with your application
 1. RESALE CERTIFICATION #:

 2. STRUCTURAL PCO #:

 3. OPERATOR ID #:

 4. AG PEST CONT. BUS. LIC. #:

 5. QAL #:
  Bond/Insurance Company:

 Address:

 Policy #:
 
ELECTRONIC SIGNATURE

  I am an officer of the company.

 Name:

 Date:

15415 Marquardt Avenue • Santa Fe Springs, California 90670 • (562) 802-2238 • (800) 352-3870 • FAX (562) 404-9113