A process is currently executing in the background, please wait for the operation to complete. Once complete your screen will refresh automatically. One moment please...
First Source
Welcome,  {{loginInformation.status.Name}}
Sign Out
Welcome, {{loginInformation.status.Name}}

New Customer Information and Credit Application
Please fill in all information. Once complete, hit submit and we will take care of the rest.

You may also DOWNLOAD .PDF FORM HERE and fax a copy to 757-566-5375

Tax Status:
Company Profile:
How did you hear about us?

Principal Owners or Officers:

Credit References (If Applying for Net 15 day terms)

Enter your contact name, phone number & email address.

Enter your contact name, phone number & email address.

Enter your contact name, phone number & email address.

Statement / Invoice:
Credit Card Information:

Shipping Needs

1. Residential Address?
3. Delivery Appointment Required?
5. Can a Carrier (18-Wheeler) Access this Location?
7. Receiving Days/Hours
2. Do you have a loading dock?
6. Inside Delivery Required?

Terms of Sale:  All orders are prepaid until credit terms are approved. Terms are 15 days from date of invoice if credit is granted.  Prices are subject to change without notice.  The minimum for 1st order/reorders is $500. This order minimum applies to all orders including customer will call, FS deliveries, UPS & orders shipped by LTL. Past due amounts are subject to interest at 1.5% per mo.

Agreement to Terms

I affirm that the information provided on this application is correct. I have read, understand, and agree to the Terms of Sale above. I personally guarantee the payment of all outstanding invoices as well as accrued interest and reasonable cost of collection, including attorney fees.

P r o c e s s i n g . . .