Poolweb - Net 30 Application

Organization Information

Organization Type: See a list of pre-approved hotels

Tax Exempt?:

Organization/Company Name:

Address:

City:

State:

Zip:

Telephone:

Since you selected 'other' as your organization type, please provide a little more information!

Type of Ownership:

Credit Line Required:

Principal Name:

Principal Date of Birth:

Principal Address:

Principal City:

Principal State:

Principal Zip:

Credit References:

Company	Contact	Email	Phone	Fax

Accounts Payable Information

Accounts Payable Contact:

Telephone:

Fax:

Email:

Credit Authorization Limits:

In order to facilitate prompt order processing, what types of orders do you permit the representatives from your organization to submit? If there is a limit to those types of orders, please indicate as well.

PO Type	Authorized	Limit
Written Purchase Order	Yes No
Verbal with PO #	Yes No
Verbal without PO #	Yes No

Authorization

We (I) understand an interest charge of 1 ½% per month (18% annum) or greater when allowed by law will be applied to unpaid balances over 30 days. We (I) agree to pay all delinquency and collection charges plus reasonable attorney’s fees and court costs when allowed by law, if my account becomes delinquent. We (I) agree to all of the terms of sale listed on www.poolweb.com We (I) authorize Aquatic Technology, Inc. to obtain any and all credit information considered necessary to evaluate this application. We (I) understand if granted charge privileges, the terms are Invoice Due Net 30 days. We (I) certify that I have read the above statements and all information provided is accurate and submitting and providing this information is your acceptance to the terms of credit and sale. WE (I) CERTIFY THAT I AM DULY AUTHORIZED TO SUBMIT THIS APPLICATION ON BEHALF OF THE APPLICANT.

By checking this box and typing my name below, I am electronically signing my application.

Your Title:

Your Email:

Your Name:

Poolweb Terms Application