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CFC#: 041766

Your Home       Your Business
Your Plumber
Orlando Plumbing Service
Customer / Business Name
Maling Address
Business Credit Application
City
State
Zip
(If more than one service address, please enter below
Purchase Orders Required
Service Contract Required
Type of Business
Business Phone
Business Fax
Email
Accounts Payable Contact
Phone
Fax
FEI#                                                        Year Established 
Principle Owner's or Officers
Dunn & Bradstreet #
Name/Title
Social Security #
Address
Phone
Name/Title
Social Security #
Address
Phone
Name/Title
Social Security #
Address
Phone
Has the company or any officer, director, or owner of the company ever filed a voluntary petition in Bankruptcy, been adjusted
If yes, who and when
Financial Institution
Address
Account Number
Contact
Phone
I (WE) acknowledge that the credti application information is true and correct. I (WE) herby authorize creditor to contact all Credit References to inquire as to the credit information provided and give my consent for creditor to receive all confidential financial information that is relevant to approving our credit account. I (WE), in making ths application for credit, the customer acknowledge receipt of Progressive Services, LLC terms of Net 30-days and agree to pay all invoices within terms and pay a Service Charge of 1-1/2% per month, which is annual percentage rate of 18% of all overdue balances. In the event a suit is necessary to collect any amount, I (WE), the customer agree to pay the sellers Attorney fees and cost including attorneys fees for appeal. 
Phone
Address
Creditor Name
Electronic Signature of Owner/Officer
Date
YES
NO
YES
NO
YES
NO
Corporation Sole Proprietor Partnership