Southeast Floors Credit Application

Please take a few minutes to fill out all of the required information. A representative from Southeast Floors will contact you after your submission.

Date * +

Account Manager *

Property Information

Property Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

First Name *

Last Name *

Email Address *

Billing Address: *

Property Address

Management Company

Other

Billing Address:

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Would you like to be invoiced via *

US Mail

Email

Email Address *

Management Company Section

Management Company *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

First Name *

Last Name *

Email Address *

Property Owner Section

Owner's Name *

FEIN *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Trade and Credit References

Please note that HD Supply does not provide credit references.

Reference #1 *

Phone Number *

Fax Number *

Email Address *

Reference #2 *

Phone Number *

Fax Number *

Email Address *

Reference #3 *

Phone Number *

Fax Number

Email Address *

Are you tax exempt? (If yes, provide your sales rep with a copy of your tax exemption certificate or attach below) *

Yes

No

Tax Exemption Certificate

Are PO's required? * *

Yes

No

I, THE APPLICANT, REPRESENT TO THE CARPET COMPANY III INC DBA SOUTHEAST FLOORS THAT I AM AUTHORIZED BY ALL OF THE ENTITIES NAMED ABOVE TO PROVIDE ANY AND ALL OF THE FORGOING INFORMATION TO SOUTHEAST FLOORS, BOTH ACTUALLY AND ELECTRONICALLY, AND THAT I AM AUTHORIZED ON BEHALF OF ALL OF THE ENTITIES NAMED ABOVE TO AGREE TO ALL OF THE TERMS OF THIS CONFIDENTIAL COMMERCIAL CREDIT APPLICATION AND CONTRACT ON THEIR BEHALF, BOTH ACTUALLY AND ELECTRONICALLY. I CERTIFY THAT THIS CREDIT REQUEST IS FOR THE EXTENSION OF CREDIT FOR BUSINESS PURPOSES ONLY AND NOT FOR THE EXECUTION OF CREDIT FOR PERSONAL, FAMILY OR HOUSEHOLD PURPOSES.

I SPECIFICALLY AUTHORIZE OUR BANK(S) AND TRADE REFERENCES LISTED IN THIS CREDIT APPLICATION TO RELEASE THE REQUESTED FINANCIAL AND CREDIT REPORTS AND REQUESTED INFORMATION TO SOUTHEAST FLOORS AND SOUTHEAST FLOORS MAY INVESTIGATE ALL CREDIT REFERENCES AND CUSTOMARY CREDIT INFORMATION SOURCES.

THIS AGREEMENT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN THE PARTIES, AND MAY NOT BE ALTERED EXCEPT IN A WRITING SIGNED BY A MANAGER OR OFFICER OF SOUTHEAST FLOORS AND THE APPLICANT AND SHALL BE CONSTRUED ACCORDING TO THE LAWS OF THE STATE IN WHICH SOUTHEAST FLOORS’ BRANCH OFFICE RESPONSIBLE FOR THE ORDER IS LOCATED OR WHERE VENUE FOR ANY SUIT IS ALLOWED AS PROVIDED HEREIN.

(I) understand that the information furnished to you on this Credit Application for an account is for the purpose of obtaining credit from SOUTHEAST FLOORS. We, (I) understand that SOUTHEAST FLOORS may at any time refuse to grant credit to me (us) even though credit is initially granted pursuant to this Application. I am (we are) authorized to bind my (our) company (in my capacity stated) for any and all credit which SOUTHEST FLOORS may extend to us (me).

It is further agreed and understood that all accounts or monies due SOUTHEAST FLOORS shall be due and payable at their offices in Orlando, Orange County, Florida. Venue and jurisdiction of any lawsuit will be in the state courts of Orange County, Florida or in the County where the Property is located, as SOUTHEAST FLOORS may elect. In addition, all past due accounts, notes, or invoices shall bear interest at the rate of 1 1/2% per month (18% per annum), (but in no event in excess of the maximum rate allowed by law) beginning thirty (30) days after the date of the indebtedness was incurred. Moreover, if the account is placed in the hands of an attorney for collection, then we (I) agree that we (I) are liable to SOUTHEAST FLOORS for additional reasonable attorney’s fees and all reasonable costs incurred in the collection of the indebtedness.

I Agree

*

E-Signature *

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