The Plumber’s Choice, Inc.

3655 LaSalle Street, Phoenix AZ 85040
Phone: 602-426-0602 / Fax: 602-426-0610 • Toll Free: 888-989-4260 / 888-989-4261
Questions? [email protected]

NEW ACCOUNT APPLICATION

Download the form, or send us your completed copy

Prefer paper or e-mail? Download the fillable PDF. Already filled it out? Upload it here along with your tax exempt form, if applicable.

↓ Download the New Account Form (PDF) Fillable in Adobe Reader, Chrome, Edge and most PDF apps.

OR FILL IT OUT ONLINE

Online New Account Application

Fields marked * are required.

Date Sales Representative Contact Name Business Name AP Contact Billing Address City State Zip Phone Fax E-Mail Shipping Address (if different) City State Zip County Fed Tax ID State Tax ID

How would you like to receive your invoices?

US Mail E-Mail

PO required?

Yes No If tax exempt please include your tax exempt form (upload below).

Applying for (Select One)

Open Account Credit Card Account

For your security, please do not send card numbers online. We will contact you directly to collect payment details after reviewing your application.

Amount Requested ($) In Business Since Owner Contact

Trade References

Please only fill out trade references if applying for an open account.

1. Name Account # City State Phone Email 2. Name Account # City State Phone Email 3. Name Account # City State Phone Email

Bank Reference

Bank Account # Address City State Zip Phone Fax

Terms and Conditions of Credit: All invoices may be paid within 10 days of invoice to earn a 2% discount. Net amount of invoice is due 30 days from date of invoice. 1 ½ % per month service charge will be added to all past due invoices. Should it become necessary to collect this account through a collection agency, attorney, by legal proceedings, or otherwise, the undersigned, promises to pay all costs incurred.

Authorized Signature (type your full name) Date Position Tax Exempt Form (PDF, max 5 MB — if applicable)

By submitting you agree to the Terms and Conditions of Credit above.