Credit Application – House Of Hardware

2

Account Information

Full Legal Name*

Primary Phone*

Email Address*

Business Legal Name*

DBA / Trade Name

Federal Tax ID / EIN*

Primary Phone*

Business Email*

Website

3

Billing & Shipping

Billing Street Address*

City*

State*

ZIP Code*

Shipping address is the same as billing.

Business Contacts

Accounts Payable Contact Name

Accounts Payable Email

Accounts Payable Phone

Purchasing Contact Name

Purchasing Email

Purchasing Phone

4

Business Background

Entity Type*

State / Country of Formation*

Years in Business*

Industry*

Owner / Principal Name*

Title / Role*

5

Bank Reference

Required only when requesting open credit terms.

Bank Name*

Account Type*

Bank Contact Name*

Bank Contact Phone*

6

Payment & Credit Request

Would you like to request open credit terms?

Yes — request Net 30 credit No — Credit Card / ACH / Wire Transfer only

7

Trade References

Please provide at least one trade reference. Up to three may be submitted.

Reference #1

Company Name*

Contact Name*

Phone / Email*

Current Terms

Reference #2

Company Name

Contact Name

Phone / Email

Current Terms

Reference #3

Company Name

Contact Name

Phone / Email

Current Terms

8

Open Credit Terms & Authorization

Payment Obligation. Customers agree to pay invoices according to approved terms.

Late Fees. Past-due balances may be subject to late fees up to the maximum amount permitted by applicable law.

Payment & Invoice Disputes. Invoice disputes must be submitted in writing promptly after the invoice date.

Credit Limit Changes. House of Hardware may adjust credit limits based on payment history and risk review.

Authorization. The applicant authorizes House of Hardware to verify the application, contact references and obtain credit-related information as permitted by law.

Privacy. Application information will be used to evaluate and manage the account, subject to applicable law and the House of Hardware privacy policy.

9

Authorized Signature

Authorized Representative / Applicant Name*

Title / Role*

Date*

Electronic Signature (type your full name)*

New Account & Credit Application

Choose your application type

Account Information

Billing & Shipping

Business Contacts

Business Background

Bank Reference

Payment & Credit Request

Trade References

Reference #1

Reference #2

Reference #3

Open Credit Terms & Authorization

Authorized Signature

Useful links

Categories

Phone Number

Email Address

Address