firepro@fpoa.com
Credit Application
Customer Information
* Applicant Name:
Accts. Payable Contact:
Business Address:
Billing Address:
City:
State: Zip:
Phone:
Fax:
* Email:
Accts. Payable Phone:
Accts. Payable Fax:
Accts. Payable Email:
PO Required?
Tax Exempt Yes    No
Recurring Credit Card Payment? Yes    No
Please Check One: Corporation Partnership Sole Proprietor Individual
Owner/Officer:
Title:
Please check all that you will need:
Additional Locations
Address 2:
City:
State: Zip:
Address 3:
City:
State: Zip:
Address 4:
City:
State: Zip:
Bank Information
Bank Name:
Bank Phone:
Bank Address:
Bank City
Bank State: Zip:
Bank Contact:
Trade References
Reference 1:
Address:
City:
State: Zip:
Phone:
Fax:
Email:
Reference 2:
Address:
City:
State: Zip:
Phone:
Fax:
Email:
Other
Please check all that you will need:
Have you ever filed for bankruptcy? Yes    No

Fire Protection of Arkansas (FPOA) may charge interest on any past due balance at the maximum rate allowed by law with said interest being calculated from the date of the default. In consideration of "FPOA" extending credit to the above business, I/we do hereby agree jointly and individually, to pay for all goods, ware and merchandise supplies to me or to any of us or the above business. In the event the account is placed with a third party for collection, I/we agree to pay all costs including reasonable attorney fees, court cost and finance charges.

Signature attest that the information provided is accurate, complete, gives authorization to check credit, financial and banking history, and accepts that invoices are due upon receipt. By signing below, I/we also Understand and Authorize all dishonored checks plus a processing fee to be electronically debited from my/our checking account.

Individual signing below is an authorized officer and/or signor for the company listed above.
Your Name:
Title:
Date:
 

FPOA Tip of the Month
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Fire Protections of Arkansas, Inc.
4008 Southwest Drive
P.O. Box 472
Jonesboro, Arkansas 72403
Phone: 870-932-2643 • Toll Free: 877-505-FIRE
firepro@fpoa.com

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