Registration | E&R Industrial

Applicant

Shipping Address (Same as above)

Street Address *

City *

State *

Zip *

Business Information

D&B No (if any)

Estimated Monthly Purchases $

Requested Line of Credit $

Preferred Carrier/Delivery instructions *

Collect # (If applicable)

EDI

Would you like to be enrolled in paperless invoicing?

If yes, this means All invoices for this account will be sent to the email address you provided above, regardless of who places the order.

Banking Information

Bank Name *

Address *

City *

State *

Zip *

Phone *

Name on Account

Fax

Business Checking Account Number (s) *

Trade References (Please fill out 3 references)

Reference Name *

Address *

Phone *

Reference Name *

Address *

Phone *

Reference Name *

Address *

Phone *

Current company personnel

Purchasing Manager

Accounts Payable Manager *

Accounts Payable Contact *

Accounts Payable e-mail *

Accounts Payable Phone *

Buyer

Controller

Production Manager

Total No. of Employees

EDI Contact Name

EDI Contact Email

Terms And Conditions

ACCEPTANCE OF TERMS AND CONDITIONS: TERMS AND CONDITIONS: All credit extended by E&R Industrial Sales, Inc. ("Seller") to Company ("Buyer") and the limits of such credit, is at Seller's sole discretion, and may be reduced or revoked by Seller at any time, for any reason. As a condition for any and all extensions of credit, Buyer agrees to the terms herein and E&R's Terms and Conditions of Sale located on www.erindustrial.com in effect at time of order ("T&Cs") and incorporated herein by this reference. Any conflicts between the T&Cs and the terms herein shall be resolved in favor of the T&Cs. PRICES: Prices and pricing terms will be those in effect at the time of order. SALES AND OTHER TAXES: Buyer is responsible for payment of all applicable state and local taxes, unless a current and valid sales tax exemption certificate is provided to Seller prior to or at time of sale. When placing an order, Buyer shall indicate which products are tax exempt. MINIMUM ORDER: Seller may require a minimum purchase of $25.00 (exclusive of sales tax) at time of order. PAYMENT TERMS: Buyer shall pay invoices in full to Seller Net 30 from date of invoice. Seller accepts payment by check, American Express, Master Card and VISA. As a condition for the continued extension of credit, Buyer agrees to provide Seller with current credit information and the latest annual financial statement within five (5) business days following request by Seller. PAST DUE INVOICES; RETURNED CHECKS: Seller reserves the right to charge Buyer a late payment fee at the rate of one and one-half percent (1-1/2%) of the amount due for each month or portion thereof that the amount due remains unpaid, or such amount as may be permitted under applicable law.. Seller reserves the right to charge a fee to Buyer in the event of a returned check. ADDITIONAL REMEDIES FOR PAST DUE INVOICES: If Buyer fails to make payment within thirty (30) days of invoice, or fails to comply with Seller's credit terms, or fails to supply adequate assurance of full performance to Seller within a reasonable time after requested by Seller (such time as specified in Seller's request), Seller may defer shipments until such payment or compliance is made, require cash in advance for any further shipments, demand immediate payment of all amounts then owed, elect to pursue collection action (including without limitation, attorneys' fees and any and all other associated costs of collection), and/or may, at its option, cancel all or any part of an unshipped order. In addition, if Buyer fails to comply with these payment terms, Seller may, at its sole discretion, and without notice, immediately terminate any agreements it has with Buyer. Upon such termination all amounts owed by Buyer to Seller shall become immediately due and payable.

APPLICANT'S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS

By (Signature) *

Title *

Date *

Any current & valid Tax Certificate of Exemption to E&R Accounts Receivable Department: AccountsReceivable@erindustrial.com

Create Online Account

Credit application for customer account

Applicant

Business Information

Banking Information

Trade References (Please fill out 3 references)

Current company personnel

Terms And Conditions