(800) 523-7902

4134 Innslake Drive Glen Allen, VA 23060

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New Account Information Sheet

Ship To (Primary & Secondary)

Shipping / Receiving

APPOINTMENTS REQUIRED?

Bill To

Accounts Payable

INVOICING METHOD

Purchasing

Products

Quality

Credit Information Request

Bank Information

Trade References - Please list 3 trade references

Authorization For Release of Credit Information

Payment Terms & Conditions

I, the undersigned, certify that upon credit approval, understand the billing terms of Industrial Commodities, Inc. are Net 15 days from the invoice date unless agreed to otherwise in writing. A late charge of 2% per moth shall be applied on invoices past due. The undersigned guarantees to pay all costs and expenses of any collection fees or legal proceedings, including reasonable attorneys’ and court fees, to collect on any delinquent account. My signature below acknowledges the receipt and acceptance of Industrial Commodities General Terms and Conditions of Sale.