Site Search




The Dubbs Company asks all new customers to fill out this New Account / Credit Application. This form will give us some basic information needed for our files and it gives us the opportunity to learn more about our new clients.

Our credit terms are "Net 15 Days". Past due balances will be charged 1.25% per month. We also accept Visa, MasterCard and American Express. Complete information as requested below must be received before a credit relationship can be established and orders processed.

Unless prior credit approval is authorized . . . deposits are required with initial orders.

FIELDS INDICATED IN RED ARE REQUIRED TO BE FILLED IN BEFORE FORM IS SUBMITTED.

Please Select One
    
Date
Your Dubbs CompanyRepresentative
Company Name
Web Address
Primary Contact Person
E-mail
Title
Phone Number
Mailing Address
Shipping Address
(If different from above)
Main Phone Number
Fax Number
Please Select One
If Other
Principal(s) & Title (for proprietorships and partnerships only)
Type of Business
Number of Years In Business
Division or Subsidiary of
Headquarters City and State
Other individual(s) involved with this account
 Name
Phone #
E-Mail
Name
Phone #
E-Mail
Does Your Company Require use of a P.O.#
If yes, for purchases over $
Sales Tax

If exempt, complete attached tax form and/or exemption certificate for each state shipped to. Tax will be charged unless a tax exemption certificate is attached.
How did you hear about us?

Name of referral.
If you've chosen other, please explain.