Name of Business (per FEIN) *

Application Date *

Work Phone #

Doing Business As (DBA)

Credit Limit Requested

Work Cell #

Business Address *

City, State, Zip *

Billing Address (if different)

Billing City, State, Zip

Home Address of Owner (if different)

FEIN Number

Contractor's License # (if applicable)

Type of Business *

Date Started (Company)

Business Entity *

LLC

Corporation

Partnership

Sole Proprietor

Municipality/Govt Entity

Existing Customer Number (if applicable)

Alliance Sales Representative Name

PO/Job Number Required?

Yes

AP Contact Name

AP Phone Contact

AP Email Contact

Have you, any officer, or any owner, ever had an account with us?

Yes

If so, when?

Under what name?

Have you, any officer, or any owner, within the past 10 years, filed personal or corporate bankruptcy?

Yes

If so, when?

Under what name?

Has the applicant ever been in business under any other names?

Yes

If so, when?

Under what name?

To induce Alliance to extend credit, a Guarantor absolutely and unconditionally guarantees prompt payment of all indebtedness of the Applicant. Complete only if a guarantor is providing a personal guaranty.

Summary of key terms (full terms provided on the printed application and in your account welcome packet):

Applicant authorizes Alliance to verify credit information from any source, credit bureau, bank, or trade reference listed.
Invoices are due per the terms stated on each invoice; unpaid balances accrue a late fee of 1.5%/month (18% APR) or the maximum allowed by law.
Alliance may decline, limit, or terminate credit at its sole discretion at any time.
Applicant grants Alliance a purchase money security interest in materials supplied until paid in full.
Alliance may report account payment history to credit reporting agencies.
This account is for commercial/business purposes only, not personal, family, or household use.
Disputes are resolved by binding arbitration in the state and county of purchase, governed by Texas law.
Any guarantor signing below unconditionally guarantees payment of Applicant's obligations without requiring Alliance to first pursue the Applicant.

By checking the box below and typing your name, you certify that all information provided is true and correct, and that you have read and agree to Alliance's full Terms & Conditions, including the arbitration and guaranty provisions referenced above.

Apply for Credit