#ACSUPPLYCO SHOP EVENTS HVAC PRODUCTS WARRANTY LOCATIONS CREDIT RESOURCES 2021 CREDIT APPLICATION Home / Credit / 2021 Credit Application Credit Application RE: CREDIT AGREEMENT 2021 Dear Prospective Customer: Thank you for considering AC Supply company as your vendor. We are a full service source for air conditioning, industrial, mechanical, ventilation and refrigeration materials. On the following page you will find our Credit Agreement. Any information provided will be held in strictest confidence and be used only for our credit granting purposes. If you do business in Texas and use your resale number, be sure to fill out the tax certificate completely. Also, to purchase refrigerant and equipment, we also need for you to include valid copies of your Texas Air Conditioning Contractor’s License (required by Texas State Law) and a valid copy of your EPA certification. On the below form you will also find our credit terms of sale. Please read them and sign at the bottom of the page. The signature of Owner(s), Partner(s), or Corporate Officer(s) is required on the Continuing Guaranty and Credit Terms of Sales. You can now order online–anytime. At the end of the agreement you can sign up to purchase at our online store. Just supply us with your user name and password and we will set you up to buy online at www.buyacsupply.com! Once all the information is filled out, SIGN PDF and fax your agreement to us at 817.922.0656 or email to l.savage@acsupplytexas.com Should you have any questions, please feel free to call us at the branch closest to you. You will find them listed below for your convenience. We look forward to serving you in the future. Best wishes for a successful and profitable year. Sincerely, A/C Supply Co., Inc. 2021 Credit Application Step 1 of 3 33% COMPANY BUSINESS NAME* Phone* Fax* Email* Street/Delivery Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Billing / Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Accounts Payable Contact* First Last Phone AP Fax Email HOW WOULD YOU PREFER TO RECEIVE INVOICES* Fax E-mail PO REQUIRED?* Yes No TAXABLE?* Yes No (IF NO, PROVIDE RESALE CERTIFICATE) ATTACH RESALE CERTIFICATE Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB. Date Business Started:* MM slash DD slash YYYY FEDERAL TAX ID #:* TYPE OF BUSINESS:* CORPORATION PROPRIETORSHIP GOVERNMENT AGENCY LIMITED LIABILITY CO LIMITED PARTNERSHIP NON-PROFIT HAVE YOU FILED BANKRUPTCY WITHIN THE LAST 10 YEARS?* Yes No IF YES, WHEN? LIST COMPLETE NAMES OF ALL OWNERS(S), OFFICER(S) OR PARTNERS NAME TITLE HOME ADDRESS PHONE SS# DL# CLICK THE + SIGN TO ADD ADDITIONAL OWNERS WERE ANY OF THESE PRINCIPLES IN THE BUSINESS BEFORE?* Yes No IF SO, GIVE NAME OF BUSINESS AND REASON FOR DISCONTINUING. NEAREST RELATIVE - NAME, ADDRESS, & PHONE* TRADE REFERENCES* Trade Name Address Phone Account #: CLICK THE + SIGN TO ADD ADDITIONAL REFERENCES BANK REFERENCES* Bank Name Address Phone Account #: CLICK THE + SIGN TO ADD ADDITIONAL REFERENCES *CONTRACTOR LICENSE #* *PLEASE ATTACH A COPY OF CONTRACTORS & EPA LICENSE IN ORDER TO PURCHASE EQUIPMENT & REFRIGERANT File Max. file size: 512 MB. *EPA LICENSE # *PLEASE ATTACH A COPY OF CONTRACTORS & EPA LICENSE IN ORDER TO PURCHASE EQUIPMENT & REFRIGERANT File Max. file size: 512 MB. Search for: Shop Online Latest on Social Media #acsupplyco Subscribe to our Mailing List: Subscribe * indicates required Email Address * Last Name * First Name * Company * SHOP ONLINE Registration Form Shop Online Guide to Shop Online Pay My Bill REFRIGERANT PT CHARTS FOLLOW US JOIN OUR MAILING LIST Subscribe to our mailing list * indicates required Email Address * Last Name * First Name * Company * WordPress Theme | Total by Hash Themes