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Products:
Screws
Socket Head Cap
Button Head Socket
Socket Set
Hex Head Cap
Square Head Set
Sheet Metal
Round Head U-Drive
Thread Cutting
Wood
Machine
Drywall
Flat Head Socket Caps
Bolts
Carriage, Plow, Elevator
A325 Structural
Lag
Square Head Machine
Shoulder Eye
Turned Eye
U-Bolts
Shoulder
Pins
Dowel Pins
Cotter Pins
Taper Pins
Roll Pins
Inserts
Solid Thread
Helicoil
Other
Anchors
Nuts
Pipe Plugs
Washers and
Lockwashers
Threaded Rods
Grease Fitting and Liner Bolts
Pop Rivets
Retaining Rings
Struts
Date: 2/6/2012
Company Information
I would like to have on-line ordering capability.
Desired Username:
- You will receive two emails; one confirming your user name and one containing your Suburban Bolt account number.
Your account number will be your password for your first login. You will then be prompted to select a new password.
*All Fields Required
COMPANY NAME:
LEGAL (if different):
Type of Business:
Years in Business:
Credit Requested:
Number of Employees:
Purchasing Manager:
Phone #:
Fax #:
Email:
BILLING Address
ADDRESS:
CITY:
STATE:
ZIP:
COUNTY:
PHONE:
FAX:
SHIPPING Address
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX:
Type of
Organization
Private Corporation
Partnership
Public Corporation
Individual
Other
Principals
NAME
POSITION
ADDRESS
PHONE#
Bank Reference
Bank:
Account #:
Branch:
Contact Name:
Address:
Phone #:
Trade References
(Minimum of 3)
NAME
ADDRESS
PHONE #
FAX #
Special Company Information
Special comments to be
included on documents:
Area of Specialization:
Resale
Retail
Electrical/Mechanical
Construction
Machine Tool Builder
Tool & Die
Automotive
Other
How did you hear
about Suburban?
Salesperson
Internet
Walk-in
Yellow Pages
Referral
Other
Will you accept Back Orders?
Yes
No
Will you accept Substitutes?
Yes
No
Yes, only with approval
Which shipping method
will you use most often?
BESTWAY
PICKUP
UPS
OUR DELIVERY
UPS CONSIGNEE: your #
Do you always
require a PO#?
Yes
No
If yes, is there a default PO#?
Experiation Date of default PO#
Any other notes or
special account requests:
In making this application for credit, the customer agrees to pay all invoices within 30 days from date of invoice. In the event a suit is necessary to collect any amount, the customer agrees to pay the seller's reasonable attorney fees and costs including attorney's fees for appeal.
Name:
Title:
Date:
