| In order to establish an account with American Drapery & Blinds, you need
to give us certain information about yourself and your property. Please fill out the secured form
below. We will contact you after processing your application.
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Required Fields= |
| BILL TO: |
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Billing Name: |
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C/O or Attn: |
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Position: |
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Address: |
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City: |
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State: |
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Zip: |
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(ex: 945447932 or 94544)
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Phone |
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(ex: 5105551212)
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| SHIP TO: |
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Name: |
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Attn: |
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Address: |
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Unit #: |
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City: |
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State: |
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Zip: |
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(ex: 945447932 or 94544)
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Phone: |
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(ex: 5105551212)
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Country: |
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| UNIT INFORMATION: |
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Number of units you own or manage: |
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Type of property you own or manage: |
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How did you hear about our Company? |
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| ORDER INFORMATION: |
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Person(s) authorized to order: |
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Will you use Purchase Orders?: |
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Limitations/Special Instructions: |
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| ACCOUNT TYPE: |
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Account: |
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| OWNER: |
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Important Instructions: This section must be completed. (Do not list a P.O. Box)Whether you are applying
under an individual, partnership or corporate account, you need to provide complete address and phone number
information. If you are a corporation or private business, you should provide this information for both the
owner and a responsible officer of the company.
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Name: |
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Address: |
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(DO NOT USE A P.O. BOX NUMBER)
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City: |
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State: |
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Zip: |
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(ex: 945447932 or 94544)
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Phone: |
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(ex: 5105551212)
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Country: |
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| RESPONSIBLE OFFICER/OTHER: |
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Name: |
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Address: |
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(DO NOT USE A P.O. BOX NUMBER)
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City: |
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State: |
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Zip: |
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(ex: 945447932 or 94544)
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Phone: |
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(ex: 5105551212)
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Country: |
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| REFERENCES: |
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Instructions: Please list only those suppliers that you have a current open established account.
Do not include any charge card references such as MasterCharge, Visa, Discover or American Express.
Examples of references to include would be hardware, paint, carpet, lumber, electrical, landscaping, or
appliance repair companies. Please try to provide at least two supplier references.
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| BANK REFERENCE: |
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Bank Name: |
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Branch Address: |
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City: |
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Phone: |
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(ex: 5105551212)
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Checking Acct. #: |
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Savings Acct. #: |
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Contact Person at Bank: |
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Title/Position: |
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| SUPPLIER REFERENCE: |
| Supplier #1 |
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Supplier Name: |
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Address: |
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City: |
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State: |
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(ex: 945447932 or 94544) |
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Phone: |
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(ex: 5105551212)
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| Supplier #2 |
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Supplier Name: |
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Address: |
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City: |
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State: |
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Zip: |
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(ex: 945447932 or 94544)
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Phone: |
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(ex: 5105551212)
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| CREDIT AUTHORIZATION: |
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Authorization: I hereby authorize American Draperies & Blinds to contact the above references for credit
information. I give my permission to these references to supply American Draperies & Blinds with the credit
information requested.
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Name: |
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Date: |
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| PAYMENT AGREEMENT: |
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Agreement: I recognize that all orders are payable net upon receipt of the merchandise. Furthermore, I
understand that shipments may be held until an entire past due balance and/or any accrued service charges have
been completely paid. I acknowledge that if payment is not received by American Draperies & Blinds within 30 days
from the date of the balance, all unpaid balances will be subject to a finance charge that will be applied at the
rate of 1.5% per month with an annual percentage rate of 18% or a minimum charge of 50 cents for balances
under $50.00. If Small Claims action becomes necessary to recover a debt, I agree to have the matter heard in
court in Hayward, California and waive the right to request a change in venue. I agree to pay for all added costs
for collection including attorney's fees, court costs, etc.
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Email: |
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Contact us at:
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