Strickland Companies appreciates the opportunity to have you as a customer. Submitting your credit application will start the process of opening your account. We look forward to building our relationship and taking care of your business needs.

Fields with a * are required before submission.

Is a sales representative calling on you? Sales Rep

Company Name     Date  

Billing Address      Phone# 

City, State Zip     Fax#  

Delivery Address (if different than billing address)  

Delivery City, State Zip  

E-mail Address  

Type of Business  

Federal ID Number  


(1)    Name     Position  


(2)    Name     Position  



Name      Phone #  

Address     Fax #  

Name      Phone #  

Address     Fax #  

Name     Phone #  

Address     Fax #  

BANK REFERENCES (1 Reference Required)

Name      Phone #  

Name     Phone #  


Do you need a statement?  

Will you pay from an emailed invoice?  

Will you pay from fax invoice?  

Do you require purchase order ?  

Do you allow merchandise to be delivered to a location other than your address?  

Is your business located within a city limit?  

Should your purchases be tax exempt?  

Name of person to contact in case of any problems with invoices:

Name   Phone #  

Email Address  

Customer grants Strickland a security interest in each purchased product and any proceeds for the amount of the purchase price until Customer has fully paid for the product. Customer hereby authorizes Strickland to file a UCC Financing Statement at any time to perfect Strickland's security interest in the products and proceeds. Customer shall not move products to another location while Strickland maintains a security interest. Upon the default of Customer, Strickland shall have, in addition all other remedies provided by law, the right to take possession, without judicial process, in any manner which does not breach the peace, of any products which Strickland then has a security interest. Upon Strickland's request, Customer shall assemble such products at Customer's own expense at a place to be designated by Strickland which is reasonably convenient to both parties.

Our terms are stated on each invoice delinquency charge of 1% per month on all past due open account balances. Failure to make payment according to our stated terms is basis for legal action and the undersigned agrees to pay all cost of collections including reasonable attorney's fees in case of suit. I hereby authorize Strickland to investigate the references herein listed pertaining to my credit, financial responsibility, and I agree to the terms stated above.

  I have read the terms and agreement statement above and I adhere to them.

Date, Signature, Title

  The information that I have filled out is correct to the best of my knowledge. I understand that any incorrect information could result in a void transaction.