Corporation   Proprietorship   Partnership   Years In Business

Officers, Partners or Owners:

  Title 
  Title 

Your Bank Account #

Address   Officer

City   State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida 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   Zip -

Phone Fax  

Current Trade Suppliers

Name                       Phone                       Address                       City, State & Zip

Sales Tax Number (Tennessee Only)

Annual Sales   D & B Rating

Requested Credit Line Amount $   PO# Required

Purchasing Contact   Phone

Payable Contact   Phone

FloorAmerica's terms are Net Ten Days because of our discounted prices. Late charges will be added after 25th day. Any accounts over 45 days will be closed and placed on Payment in Advance. Extended terms for a special project will be considered if discussed in advance.

Shipping: We will ship UPS Ground prepaid and add to your invoice. Overnight & 2nd Day service, we will need your account number for UPS, Federal Express or Airborne. All truck freight will be shipped collect or billed to your account.

Orders under $150.00 will incur a $7.50 shipping & handling charge.

Ship To Address:

Business Name 

Mailing Address   

City   State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida 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   Zip -

Preferred Freight Carrier

UPS Account Number  

Fed-X

Airborne

Other

I have read and understand the above terms and conditions of our company's credit relationship with FloorAmerica. I agree to abide by said terms and conditions.

Authorized Officer of

Name:   Date:

We also except.

FloorAmerica
PO Box 100179
Nashville TN 37224-0179

Voice: (615) 256-5723
Fax: (615) 254-9272
Email: order@flooramerica.com