Become a Customer

New Customer Application

The undersigned company is applying for credit with F. Nasiff Jr. & Co., Inc and agrees to abide by the standard terms & conditions as listed below.

Company Info

Company: *

Federal Tax ID *

Date Established: *

Applicant Name: *

Applicant Title: *

Address: *

Address 2:

City: *

State: *

Zipcode: *

Email Address: *

Phone: *

Fax:

Owners Name: (if different than above)


Accounts Payable

Contact First Name: *

Contact Last Name: *

Email Address: *

Phone: *

I prefer to be contacted by: *

Have you ever applied for credit with us before? *

If yes, under what name?

Would you like to setup auto-pay by credit card? *

On Mondays Nasiff will charge your card on file for the previous week's purchases. A payment receipt will be sent to you via email.


Trade References

Reference #1

Name: *

Phone: *

Address: *

AccountContact:

Acct #:

Reference #2

Name: *

Phone: *

Address: *

AccountContact:

Acct #:

Reference #3

Name: *

Phone: *

Address: *

AccountContact:

Acct #:


Bank Reference

Once the application is submitted, someone from our credit team with be in contact for further information that is required for a complete credit history.

Bank Name: *

Contact Person:

Phone: *

Fax:


The information in this application is true and complete, and is made for the purpose of establishing a line of credit. F. Nasiff Jr. & Co., Inc. is authorized to obtain any information it considers necessary, from any source concerning the statements herein. The undersigns agrees to pay all invoices when due within the terms stated on the invoice. The undersigned further agrees to pay a late service charge on the past due amounts in the event it is necessary to incur collection costs or institute suit to collect this amount. The undersigned agrees to pay such expenses, including collection agency costs, reasonable attorney fees (33% of total debt due F. Nasiff Jr. & Co., Inc.), court costs, etc. Debtor agrees that payment becomes due immediately if purchaser sells out, assigns, burns out, is sued or attached or becomes insolvent or bankrupt. F. Nasiff Jr. & Co., Inc. reserves the right to alter or suspend credit at anytime.