(781) 825-8500 Contact Us Employee Login Sales Request Home Company Services Locations Resources Applications Home / Applications Applications To apply for a line of credit please fill out the credit application form below. When you have completed it please click submit and it will go directly to our credit department for processing. If you prefer to download a PDF version please download the form that meets your needs. Upon completion please ubmit it to our credit department at ar@indpipe.com or by fax to 781-821-8895. If you have any questions along the way, please contact us at ar@indpipe.com or 781-828-8500. Please see below to choose which method suits your needs best. Download Corporate Application Download Individual Application Corporate Individual Credit Application – Corporate Please fill out the Credit Application below, or you may download a copy of the credit application here and fax it to 781-821-8895. Company Name Address Address Line 1 Address Line 2 City State Zip Code Phone Date Business Started Incorporated Under Laws of the State of - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Fax Type of Business PLBG HTG REFRIG AC Type of Account Individual Account Partnership Account Please state your full and complete legal name: First Name Middle Name Last Name Business Address Phone Email Residence Address Phone Social Security No Spouse's Name Number of dependents Name and Address of Nearest Relative or Friend (Not Living With You): Do you own your own residence? Yes No Please indicate your monthly mortgage or rent payment: CREDIT REFERENCES:* For each case please indicate whether the account is in your name, your spouse's or another person, a joint account or in the name of the applicant business. CLICK + BUTTON TO ADD MORE REFERENCES Credit References: Name of Bank Address, City Account # In whose name Trade References:* CLICK + BUTTON TO ADD MORE REFERENCES Trade References Company Name and Address Phone Number Other Credit References Sales Tax Sales Tax No Sales Tax Are purchase order numbers required? Yes No PERSONS AUTHORIZED TO PICK UP AT THE COUNTER: All Employees Only the following employees I/We authorized the person or rm to whom this application is made to investigate the references listed pertaining to my/our credit responsibility. Furthermore, I agree to the terms of sale and returns policy of your company and all reasonable costs, collection fees, attorney’s fees and expenses incurred by me in the event of failure of applicant to pay all obligations and indebtedness when due. (Our terms include 11⁄2% Service Charge per month (18% per annum) on the unpaid balance after 30 days of the Statement date. President Treasurer Clerk PERSONAL GUARANTY In consideration of the extending of the credit to the above company at my request, I hereby guarantee to Independent Pipe & Supply Corp. the prompt payment, when due, of every claim and debt of the above company to Independent Pipe & Supply Corp. This guarantee is given by accepting these terms in order to induce Independent Pipe & Supply Corp. to extend credit to the above named company. I hereby agree to bind myself to pay Independent Pipe & Supply Corp. on demand any sum, which may be or become due to Independent Pipe & Supply Corp. by the company whenever the company shall fail to pay the same. At its election and in its sole discretion, Independent Pipe & Supply Corp. may demand and collect payment of overdue amounts, costs and Attorneys’ fees on the above account from either the above company or the individual who submits this form. It is agreed suit may be brought in the Commonwealth of Massachusetts. This individual Guaranty is continuing and may only be revoked prospectively. Any such revocation to be effective must be signed and in writing. NOTICE: All notices and agreements shall be in writing and the parties can use the U.S. mails, any delivery service, which obtains and will furnish a signature evidencing delivery to the addressee or a Fax transmission, which provides sender with a record of such transmission being received. I agree to the above terms and conditions. SALES REQUESTS Let's work together to fulfill your needs Enter your sales request information below and one of our experts will reach out to you shortly. File Upload Choose File NEWSLETTER SIGN-UP Subscribe to our newsletter Be the first to know about special offers, promotions, events and free stuff! Please keep me informed about New products Promotions Free Stuff Special Offers Events All of the above None of the above FOLLOW US LinkedIn Facebook COMPANY About Us Our Mission Market Reports Careers In the News PRODUCTS Overview Manufacturers Valve Cross Reference Line Card APPLICATIONS Corporate Credit Application Individual Credit Application SALES REQUEST Download our Line Card MORE Services Locations Contact Us CORPORATE HEADQUARTERS: 6 Whitman Road | Canton, MA 02021 Phone: (781) 828-8500 Fax: (781) 821-8895 Email: sales@indpipe.com Privacy Policy | Terms of Use © 2021 Independent Pipe & Supply Corp. All rights reserved.