EXISTING CUSTOMER

To submit your form electronically, Please fill out the form below.

This form must be completed in order for PACIFIC CORRUGATED PIPE CO. to extend credit to the specific location of the Company listed below. This executed Existing Customer - Location Credit Authorization is incorporated into the Master Customer Application and Agreement for Credit between Existing Customer listed below and PACIFIC CORRUGATED PIPE CO.
EXISTING CUSTOMER (“”Buyer” or “Corporate Office”):
Company Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone
Fax
LOCATION TO ADD TO MASTER CUSTOMER APPLICATION AND AGREEMENT FOR CREDIT (“New Location”):
Location Name*
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Fax
Resale Certificate Number for New Location if Applicable
Please Select One*
- Send Invoices to Corporate Office
- Send Invoices to New Location
Purchase Orders Required?*
- Yes
- No
Purchase Orders Sent By:*
- Corporate Office
- New Location
I acknowledge that I have read and have authority to commit the business named above to the Terms and Conditions of Sale appearing in PACIFIC CORRUGATED PIPE CO.’s Master Customer Application and Agreement for Credit, that the same shall apply to govern all sales by PACIFIC CORRUGATED PIPE CO. to the undersigned and I hereby acknowledge receipt of a copy of these documents and the aforementioned Terms and Conditions of Sale.
This form and agreement may only be signed by a person authorized to bind and obligate the business named, whether a corporation or otherwise, to the terms and provisions herein. The person who has signed this form and agreement represent that he or she is duly and legally authorized to bind and obligate the business named to the referenced terms and conditions.

CORPORATE OFFICE:
AUTHORIZED REPRESENTATIVE SIGNATURE*
AUTHORIZED REPRESENTATIVE NAME*
AUTHORIZED REPRESENTATIVE TITLE*
Date*
Date Format: MM slash DD slash YYYY
NEW LOCATION:
AUTHORIZED REPRESENTATIVE SIGNATURE*
AUTHORIZED REPRESENTATIVE NAME*
AUTHORIZED REPRESENTATIVE TITLE*
Date*
Date Format: MM slash DD slash YYYY
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EXISTING CUSTOMER — LOCATION CREDIT AUTHORIZATION

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