Registration | Wurth USA

Name/Company Name

*Phone #

*Email Address

Fax

Owner

*First Name

*Last Name

Email Address

Alternate

*First Name

*Last Name

*Title

*Date company started

*How many technicians do you have?

Email Address

* Business Codes

Net 30 (Requires approval by WURTH USA)

Credit Card

*Fax (Mandatory when COD is selected)

Card Number

Do you pay by:

Statement

Invoice

How would you like your monthly statements sent:

Fax

Mail

A/P Contact Email

Is a PO# Required on an invoice?

Yes

No

Do you want each PO to have a separate invoice?

Yes

No

Company Name

Address

Fax

Account #

TSR#

PG#

NA#

TSR Name

District

TSR Email

Comments

Order Pending

*Please sign with your full name as your digital signature to authorize this account set up

			
The company whose name appears on the reverse side, or adjoining page entitle "New Account Form",and to whom an open line of credit is extended, will be notified in writing, advising of the amount of credit extended. All applications approved for credit are governed by the following:

1. No shipments will be made to any account, on an open basis, that will cause an account to exceed the established line of credit.
2. If an account reaches 30 days past due, orders are subject to hold until the account is made current.
3. A finance charge of 1.5% per month (or the maximum allowable by law) will be charged on past due balances until the account is paid in full.
4. A $20.00 handling charge is assessed to returned checks.
5. The foregoing statements and accompanying financial statements are correct and were provided to induce Wurth USA, Inc. to extend open credit to the person, firm, or corporation applying.
6. Payments will be made in accordance with the terms so stated on each invoice.
7. In the event of non-payment and the institution of legal proceedings, the person, firm or corporation to whom an open account was extended agrees to bare the expense of all collection, legal proceedings, plus reasonable attorney's fee.
8. Advance notice will be given to Wurth USA, Inc. of any change in the business structure (example: incorporation, changed ownership, etc.): and that without such notice the original principals to whom credit was extended shall remain liable.
9. Credit policies, including terms and credit limit, are subject to change at the discretion of the Credit Management Department. Upon acceptance of this application, and the issuance of an open line of credit, the applicant agrees to abide by the credit policies of Wurth USA, Inc.
10. If all information on front page is not filled out completely you may receive a call from our Credit Management Department to verify missing or incomplete information.

I agree to the terms and conditions

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