New Customer Set Up Form COMPANY INFORMATIONFull Legal Company Name(Required)DBA (if applicable): Physical Address:(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is Billing Address Different from Above? Yes Billing Address (if different from above): Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Company (if applicable):Nature of Business Company Type:(Required) Sole Proprietor LLC Partnership Corporation Other: Company Start Date MM slash DD slash YYYY State Incorporated AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Tax Exempt*: Yes No *if tax exempt, provide signed certificate with this application.Upload Tax Exempt CertificateMax. file size: 50 MB. Federal Tax ID:DUNS #:CONTACT INFORMATIONPrimary Contact Name(Required) First Name Last Name Primary Contact Email(Required) Primary Contact Phone(Required)Purchasing Contact Name(Required) First Name Last Name Purchasing Contact Email(Required) Purchasing Contact Phone(Required)Accounts Payable Contact Name(Required) First Name Last Name Accounts Payable Contact Email(Required) Accounts Payable Contact Phone(Required)Preferred Invoicing Method:(Required) Email Mail Customer Portal *if invoices are to be submitted via portal, please send portal setup information with this application.PAYMENT OPTIONSPayment Options Credit Card Bank Institution NameInstitution Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Account #Bank Reference Contact Name First Last Bank Reference Contact Email Bank Reference Contact PhoneCC Payment Primary Contact Name First Last CC Payment Primary Contact Email CC Payment Primary Contact PhoneNET 30 ACCOUNT SETUP - TRADE REFERENCESTrade Reference 1 - Company NameTrade Reference 1 - Account #Trade Reference 1 - Primary Contact Name First Last Trade Reference 1 - Primary Contact Email Trade Reference 1 - Primary Contact PhoneTrade Reference 2 - Company NameTrade Reference 2 - Account #Trade Reference 2 - Primary Contact Name First Last Trade Reference 2 - Primary Contact Email Trade Reference 2 - Primary Contact PhoneTrade Reference 3 - Company NameTrade Reference 3 - Account #Trade Reference 3 - Primary Contact Name First Last Trade Reference 3 - Primary Contact Email Trade Reference 3 - Primary Contact Phone Terms & Conditions:(Required) I agree to the Terms & ConditionsThis application is submitted by the undersigned (hereafter referred to as “Applicant”) for the purpose of establishing an account with Cornerstone Mechanical Services, LLC. All representations above are accurate, complete, and truthful to the best of the Applicant’s knowledge and belief. Applicant confirms that he/she is authorized in his/her capacity to bind his/her firm to the following terms and conditions. Applicant agrees and understands that the terms of Cornerstone Mechanical Services, LLC are as follows: 1) All COD accounts are due at the time-of-service delivery and will be charged to the account information listed above. 2) For all approved credit accounts, all accounts, or monies due shall be due and payable to Cornerstone Mechanical Services, LLC thirty (30) days from the invoice date, unless extended term contracts have been agreed to and signed upon. 3) Any payments due under this agreement which are not received on the date due are subject to a late payment charge of 1.5% per month. 4) Any balance over 30 days past due will automatically result in the account being put on credit hold and will not be released until all balances are paid in full. 5) Unless otherwise specified, payment is due in Seagoville, TX. 6) If any installments or payments due are placed for collections, the Applicant agrees to pay all court costs, attorney fees, collection fees, and other fees related to the collection of the past due amounts. The applicant agrees that legal jurisdiction of all contracts shall be Dallas County, TX. 7) All credit information must be filled in completely. Any missing information from this form may result in a delay in credit approval. This authorizes the above listed financial institution(s) and trade references to release deposit, loan, trade, payment record, & other pertinent credit information to verify credit and financial responsibility. Applicant Name(Required) First Last Applicant Title:Date(Required) MM slash DD slash YYYY Δ
