Online Credit Application

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 entire form below. We will contact you after processing your application.

*Required Fields

BILL TO

*Billing Name:
*Attn:
*Street Address:
*City:
*State:
*Zip:	(ex: 945447932 or 94544)
*Daytime Phone:	(ex: 5105551212)
Fax:	(ex: 5105551212)

Ship To

*Name:
*Attn:
*Street Address:
Unit #:
*City:
*State:
*Zip:	(ex: 945447932 or 94544)
*Daytime Phone:	(ex: 5105551212)

Unit Information

Number of units you own / manage:
Type of Units:

Order Information

Person(s) authorized to order:	1. 2. 3.
Will you use Purchase Orders:	No Yes
Limitations/Special Instructions:

Account Type

*Account:

Owner or Partner

*You must enter the Contact Information for EITHER an Owner or a Partner/Responsible Officer/Other. Which will you be choosing to enter below?

Owner
Partner/Responsible Officer/Other

Owner

*Note that you must enter EITHER* an Owner or Partner/Reponsible Officer/Other**
Do not list a P.O. Box or Business Address
Name:
Home Address:
City:
State:
Zip:	(ex: 945447932 or 94544)
Home Phone:	(ex: 5105551212)
Drivers License:
Social Security#:	(ex: 000000000)

Partner, Reponsible Officer, Other

*Note that you must enter EITHER* an Owner or Partner/Reponsible Officer/Other**
Do not list a P.O. Box or Business Address
Name:
Home Address:
City:
State:
Zip:	(ex: 945447932 or 94544)
Home Phone:	(ex: 5105551212)
Drivers License:
Social Security#:	(ex: 000000000)

References

*Instructions: Please list only those suppliers that you have a current open established account for your rental property. Do not include any charge cards references such as Sears, Macy's, MasterCharge or Visa. Examples of references to include would be hardware, paint, carpet, lumber, electrical, landscaping, or appliance repair companies. Please provide at least two suppliers.

Bank Reference

*Bank Name:
Branch Address:
City:
*Phone:	(ex: 5105551212)
*Checking Acct. #:
Savings Acct. #:
Contact Person at Bank:
Title/Position:

Supplier Reference

*Supplier #1*
*Supplier Name:
Address:
City:
State:
*Zip:	(ex: 945447932 or 94544)
*Phone:	(ex: 5105551212)
*Supplier #2*
Supplier Name:
Address:
City:
State:
*Zip:	(ex: 945447932 or 94544)
*Phone:	(ex: 5105551212)

Payment Agreement

1. ALL PAYMENTS ARE DUE IN FULL NET UPON RECEIPT OF THE MERCHANDISE.
2. A 1.5% per month (18% annually) service charge will be assessed on all overdue unpaid balances if payment is not received within 30 days from the date of the invoice.
3. This account will be the sole financial responsibility of said company or individual as mentioned above and signed via fax.
4. ABD, Inc. may at its option withhold shipment of any orders to customers having an amount past due until the entire past due balance and/or any service charges are completely paid.
5. If Small Claims action is necessary to recover an unpaid debt, I agree to waive the right to request a change of venue. I agree to have this matter heard before the Court in Hayward, California.

© 2007 American Drapery & Blinds. All rights reserved.

1168 San Luis Obispo Avenue Hayward, CA 94544 510-487-3500 or 800-972-0660
6965 Luther Drive Suite 5 Sacramento, California 95823 ( 916 ) 422 - 7000 or (877) 422-7001

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