Customer Application


Bill To Address


Ship To Address

Same As 'Bill To Address'?
Trade References

Supplier #1

Supplier #2

Supplier #3


Credit is extended only for 30 days from delivery of merchandise. Thereafter customer expressly aggress to pay interestat the rate of 1% per month (18% APR) finance charge on the unpaid balance,together with all costs of collection including reasonable attorney's fees.

All Statements made herein are true and accurate to the best of my knowledge. I authorize Allston Supply to make any and all inquiries necessary for action on this application. I hereby indemnify Allston Supply and its agents, from any liability resulting from their credit survey.