Legal Business Name *

DBA / Trade Name

Email *

Phone Number

Company Website *

Tax ID/EIN *

Billing Address *

Shipping Address

Leave blank if same as billing

Type of Business *

Years in Business *

State Tax ID Documentation *

Choose file or drag here

Supported format: JPG, JPEG, PDF, PNG, GIF, SVG.

How did you hear about us? *

Owner/Officer Information

Owner/Officer First Name *

Owner/Officer Last Name *

Title *

Accounts Payable Information

Phone *

Email *

Exemption or Resale Certificate

Choose file or drag here

Supported format: JPG, JPEG, PNG, PDF.

If you are a reseller or tax exempt please upload your certificate here.

Requested Credit Limit *

Estimated Monthly Purchases

Bank Reference

Bank Name *

Branch Location

Phone

Trade Reference 1

Company Name *

Contact Name

Phone *

Email *

Trade Reference 2

Company Name *

Contact Name

Phone *

Email *

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Company Name *

Contact Name

Phone *

Email *

Net 30 terms. Approved accounts are invoiced on Net 30 terms: payment is due 30 days from the invoice date.

Early payment discount. Pay before delivery and take 2% off; pay more than 15 days early and take 1% off.

Late payments. Balances not paid by their due date are subject to a finance charge of 1.5% per month. We may place orders on hold or change your terms while an account is past due.

Approval. Credit limits and terms are set at our discretion and may be reviewed or changed at any time.

View our full terms on our website.

Authorized Signer Name

Authorized Signer Title

Signature

Clear

By signing above, I certify that I am authorized to apply for credit on behalf of the business named above and that the information provided is true and complete. I authorize Russo's Restaurant Equipment & Supply LLC to contact the bank and trade references listed and to obtain credit reports on the business to evaluate this application and review the account in the future. I agree that purchases on credit are subject to the terms above and the order terms at https://russoequip.com/pages/order-terms, as updated from time to time.

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Business Information

Owner/Officer Information

Accounts Payable Information

Bank Reference

Trade Reference 1

Trade Reference 2

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