If you would like to open an account with us, please fill this application form:

First/Last Name:
Job Title:
Company:
Street Address:
City:
State:
Zip:
Phone/extension:
Email:(optional)
FAX:(optional)

Please indicate if you would like the following referenced on your billing:(optional)
Client's Name
Job Number
Reference Number
Other
 

Personnel authorized to place orders, please indicate if any:

Please list three credit references:
Name:
Phone:
Address:
 
Name:
Phone:
Address:
 
Name:
Phone:
Address:

 

Billing Policy

SpecialT bills twice monthly. All statements are due and payable upon receipt. SpecialT can bill weekly or monthly if necessary with a minimum billing of $10.00 per billing statement. All accounts not paid within 10 days of receipt shall be assessed a service charge of 1.5% per month. If legal action is necessary to collect past due accounts, the prevailing party shall be entitled to an award of all costs of collection, including attorney's fees and all costs of litigation.

These terms and conditions are agreeable and we wish to open an account: