Account Application

Location you wish to open a charge account(Required)

Westhampton True Value (223 Montauk Hwy, Westhampton Beach, NY 11978)

North Fork True Value (1403 Main Rd, Jamesport, NY 11947)

Name(Required)

First Last

Phone(Required)

Primary Email(Required)

Would you like us to email invoices / statements?

Invoices (at time of sale)

Statements (first of the month)

List email addresses youd like to recieve invoices/statements to if different from your primary email

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account type(Required)

Business

Personal

Business type(Required)

Business / Corporation Name(Required)

Own or rent current address

Own

Rent

Years at this address

Years in business

Monthly Credit Requested(Required)

Business address (if different from mailing address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you sales tax exempt?

Yes

Sales tax ID #(Required)

Upload tax exempt form

Max. file size: 128 MB.

References (other suppliers you have accounts with. Include addresses, phone #s and account #s)

Business

Phone

Account

Personnel authorized to sign on account

Credit Information release and terms (Westhampton)

I DO HEREBY AUTHORIZE THE RELEASES TO NUTS & BOLTZ WORKS, INC. ANY AND ALL INFORMATION REQUESTED BY THEM IN THE PROCESSING OF THIS CREDIT APPLICATION. I DO HEREBY AGREE THAT THE CREDIT TERMS ARE NET CASH DUE THE 28TH OF THE MONTH FOLLOWING THE CHARGE. A LATE CHARGE OF 1 1/2% PER MONTH (THE CORRESPONDING ANNUAL RATE IS 18%) WILL BE CHARGED ON BALANCES OUTSTANDING AT THE CLOSE OF THE NEXT BILLING CYCLE. IT IS MUTUALLY AGREED THAT IF THIS ACCOUNT IS PAST DUE AND SENT TO AN ATTORNEY FOR COLLECTION, THERE SHALL BE AN ATTORNEY’S FEE OF 40% OF THE AMOUNT DUE, AND THE ATTORNEY’S FEES ARE AGREED TO BE REASONABLE. YOU ALSO AGREE THAT WE MAY REPORT YOUR PERFORMANCE UNDER THIS AGREEMENT TO CREDIT BUREAUS AND OTHERS WHO MAY LAWFULLY RECEIVE SUCH INFORMATION.

Credit Information release and terms (Jamesport)

I DO HEREBY AUTHORIZE THE RELEASES TO NORTH FORK BOLTZ WORKS, INC. ANY AND ALL INFORMATION REQUESTED BY THEM IN THE PROCESSING OF THIS CREDIT APPLICATION. I DO HEREBY AGREE THAT THE CREDIT TERMS ARE NET CASH DUE THE 28TH OF THE MONTH FOLLOWING THE CHARGE. A LATE CHARGE OF 1 1/2% PER MONTH (THE CORRESPONDING ANNUAL RATE IS 18%) WILL BE CHARGED ON BALANCES OUTSTANDING AT THE CLOSE OF THE NEXT BILLING CYCLE. IT IS MUTUALLY AGREED THAT IF THIS ACCOUNT IS PAST DUE AND SENT TO AN ATTORNEY FOR COLLECTION, THERE SHALL BE AN ATTORNEY’S FEE OF 40% OF THE AMOUNT DUE, AND THE ATTORNEY’S FEES ARE AGREED TO BE REASONABLE. YOU ALSO AGREE THAT WE MAY REPORT YOUR PERFORMANCE UNDER THIS AGREEMENT TO CREDIT BUREAUS AND OTHERS WHO MAY LAWFULLY RECEIVE SUCH INFORMATION.

Personal guarantee of payment (Westhampton)

IN CONSIDERATION OF ONE DOLLAR AND OTHER GOOD AND VALUABLE CONSIDERATION THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED I (WE) HEREBY GUARANTEE UNTO NUTS & BOLTZ WORKS, INC. THE PAYMENT OF ANY INDEBTEDNESS OF (NAME OF THE ACCOUNT) NOW EXISTING OR WHICH IS INCURRED HEREAFTER AND IN WHATEVER FORM IT MAY BE EVIDENCED. THIS IS TO BE A CONTINUING GUARANTEE UNTIL ALL PAYMENT OF INDEBTEDNESS IS MADE. IT IS NOT TO BE LIMITED IN ANY MANNER. WHEN AND IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN ATTORNEY FOR COLLECTION OF ANY AMOUNTS UNPAID AND OWING, I (WE) GUARANTEE AND AGREE TO PAY ATTORNEY’S FEES OF 40% OF THE AMOUNT DUE WHICH IS AGREED TO BE REASONABLE FOR COLLECTIONS, IN ADDITION TO THE AMOUNT OF THE UNPAID BALANCE DUE.

Personal guarantee of payment (Jamesport)

IN CONSIDERATION OF ONE DOLLAR AND OTHER GOOD AND VALUABLE CONSIDERATION THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED I (WE) HEREBY GUARANTEE UNTO NORTH FORK BOLTZ WORKS, INC. THE PAYMENT OF ANY INDEBTEDNESS OF (NAME OF THE ACCOUNT) NOW EXISTING OR WHICH IS INCURRED HEREAFTER AND IN WHATEVER FORM IT MAY BE EVIDENCED. THIS IS TO BE A CONTINUING GUARANTEE UNTIL ALL PAYMENT OF INDEBTEDNESS IS MADE. IT IS NOT TO BE LIMITED IN ANY MANNER. WHEN AND IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN ATTORNEY FOR COLLECTION OF ANY AMOUNTS UNPAID AND OWING, I (WE) GUARANTEE AND AGREE TO PAY ATTORNEY’S FEES OF 40% OF THE AMOUNT DUE WHICH IS AGREED TO BE REASONABLE FOR COLLECTIONS, IN ADDITION TO THE AMOUNT OF THE UNPAID BALANCE DUE.

Signature(Required)

BY TYPING YOUR NAME BELOW, YOU AGREE TO THE "CREDIT INFORMATION RELEASE AND TERMS" AND "PERSONAL GUARANTEE OF PAYMENT" AS LISTED ABOVE

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