ELLIOTT ELECTRIC SUPPLY
2526 North Stallings Drive • PO Box 630610 • Nacogdoches, TX 75963-0610
Oce (936) 569-1184 • Watts (888) 569-7943 • Fax (936) 715-4084 • ElliottElectric.com
APPLICATION FOR CREDIT
*** Continue and Sign on Next Page ***
CREDIT-APP_2018-06-1-W page 1 of 2
Company Name ___________________________________________________________________________
Billing Address ____________________________________________________________________________
City_______________________________________________ State _____________ Zip _________________
Shipping Address _________________________________________________________________________
City_______________________________________________ State _____________ Zip _________________
Telephone ___________________________________ Fax _________________________________________
Years in Business ____________ Number of Employees ____________
Business Type: Sole Proprietor Corporation Partnership
Fed ID#________________________________ SS# _______________________________________________
DL#___________________________ DL State _______________________ Date of Birth ________________
EDI Transmissions
Yes
No
Email Invoices
Yes
No
Email
___________________________________________________________________________
Fax Invoices Yes No Fax No. __________________________
Mail Invoices Yes No Number of Invoice Copies _______
PO Preferred Yes No Include Price on Ship Tickets Yes No Partial Shipments Accepted Yes No Send Catalog Yes No
Name ___________________________________________________________________________________
Address _________________________________________________________________________________
DL#___________________________ DL State _______________________ Date of Birth ________________
Name ___________________________________________________________________________________
Address _________________________________________________________________________________
DL#___________________________ DL State _______________________ Date of Birth ________________
Name ______________________________ Phone __________________ Acct. No. _____________________
Name ______________________________ Phone __________________ Acct. No. _____________________
Name ______________________________ Phone __________________ Acct. No. _____________________
Name ______________________________ Phone __________________ Acct. No. _____________________
General InformatIon
ServIce InformatIon
name & addreSS of owner(S), Partner(S) or corPorate offIcer(S)
trade (credIt) referenceS
Get Elliott Reward$ and Eliminate Paper! Select to receive invoices by email only or via EDI and earn 10¢ per invoice. Invoices that are also
sent by mail or fax are not eligible for Reward$. Find out more at: elliottelectric.com/Features.Rewards.aspx
Name _______________________________________________
Address ______________________________________________
Send Catalog Yes No
Name _______________________________________________
Address ______________________________________________
Send Catalog Yes No
addItIonal contactS
Print Form
Clear Form
Category %
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Residential
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Multi-Family
Commercial
Light Commercial
Large Commercial
Industrial
Oil & Gas
Water / Wastewater
Food Processing
Farming & Dairy
Mining
Utility
Service Work
Residential
Commercial
Category %
Home Builder
Single Family
Track Builder
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Light Commercial
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Engineering Commercial
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End User / MRO
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Category %
End User / MRO (continued)
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National Accounts
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Competitor
The Terms and Conditions as defined on this page are the conditions set forth on each
and every sale conducted by ELLIOTT ELECTRIC SUPPLY. Any deviations from this policy
can only be approved by the President of ELLIOTT ELECTRIC SUPPLY.
LIMITATIONS OF LIABILITY
THE GOODS SOLD TO THE BUYER ARE SOLD "AS IS", AND THE SELLER DISCLAIMS
ANY IMPLIED WARRANTIES WITH RESPECT TO THE GOODS, INCLUDING, BUT NOT
LIMITED TO, ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE.
Seller has made no affirmation of fact or promise relating to the goods being sold that
has become any basis of this bargain.
For breach of this agreement, or any damages caused by defective, damaged, or
malfunctioning goods sold to or to be sold under this agreement, the buyer agrees
to be limited to the repair or replacement of the goods, or the refund of the purchase
prices at the seller's option, as the sole and exclusive remedy. Seller shall not be liable
for any incidental or consequential damages.
PAYMENT TERMS
Discounts are allowed as stated on the invoices if paid by the 10th of the month
following billing, Net 15th of month and considered past due thereafter. All payments
are payable at 2526 N. Stallings Drive, Nacogdoches, Nacogdoches County, Texas. It is
further agreed that each past due invoice will be charged a service charge of 1.5% per
month, not to exceed 18% per annum. It is also understood and agreed that if this sale
is placed in the hands of an attorney, and/or collection agency, the Buyer agrees to pay
all expenses, including court costs, legal and administrative expenses, attorney and/or
collection agency fees paid or incurred by ELLIOTT ELECTRIC SUPPLY.
RECEIPT OF GOODS
Terms of delivery made by our truck are FOB DESTINATION. All material becomes the
property of the purchasers when the delivery is signed for. Any claims for damage
or shortage must be made at the time of delivery and must be noted in the delivery
receipt.
Terms of delivery by common carrier -- FOB SHIPPING POINT.
All material becomes the property of the purchaser when delivered to the carrier by
ELLIOTT ELECTRIC SUPPLY or the manufacturer. Note any damage or shortage on the
delivery receipt and file claim with carrier.
RETURNED GOODS
Merchandise returned for credit will be subject to the Manufacturers Return Goods
Authorization Terms and Conditions. Buyer agrees that any deviation or termination
after placement of the order could result in a service charge being added to the original
order.
Initial
(Required)
: _____________
BuSIneSS claSSIfIcatIon (please indicate in each relevant category the percent of your total business. Total should equal 100%)
termS and condItIonS of Sale (please initial below)
Salesperson ______________________________________________________________________________
Date ___________________________________________________ Store # ___________________________
SaleS InformatIon (to be completed by salesperson)
Complete and email to: applications@elliottelectric.com or fax to: 936-715-4084 or mail to: Elliott Electric Supply, PO Box 630610, Nacogdoches, TX 75963
(continued—page 2 of 2)
*** Please include Tax Exemption Certicate if Tax Exempt ***
The undersigned does hereby agree that this account will be due by the 10th of the month following billing.
Items not paid by the 25th following due date will be charged a service charge of 1.5% per month, not to exceed 18% per annum.
Company Name __________________________________ By __________________________
In consideration of extending credit to the above applicant, the undersigned does hereby guarantee payment of the above account on demand.
Signature __________________________________ Date __________________
Company Name ___________________________________________________________________________
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