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SPS New Account Request Form

- required field 
Type: *

Billing Address

Billing Address is the same as Shipping Address. *

Shipping Address

Add an additional shipping address? *
To add additional shipping addresses, please contact your sales account manager.

Contact Information

Business Information

What type of services does your company provide? *
What purchasing methods do you use?
 
Preferred payment method? *
*Requires authorization for credit check or two trade references preferably within medical field
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Owners/Officers Information
_____________________________________________________________________________________________________
Filed for bankruptcy protection? *
Claim Sales Tax Exemption? *

Bank Information

Account Numbers
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Trade References

Authorized Purchasers

Payment Terms

As an SPS account holder, you agree to payment within your account’s terms. These terms will be based on SPS’ credit review, and may change based on account payment history or other factors. Past due invoices are subject to a finance charge of 1.5% per month. Applicant agrees that should it be necessary to employ a collection agency or attorney to collect monies due, applicant will be responsible for all reasonable costs of collection. As an inducement to grant credit, the undersigned authorizes and releases all businesses, banks, and persons identified on this application to furnish any and all information requested by SPS or its representative, by telephone or written correspondence. The undersigned further warrants that the information provided is true and correct. *
As of January 1, 2019, all invoice and statements will be sent via email. If you'd like to receive mailed or faxed invoices, please call 800-767-7776 x6. *
Authorized Signature for Payment Terms *
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Authorization for Credit Check

By signing this application, I authorize SPS or its agent to investigate my business credit and financial records including my bank records. As part of such investigation, I authorize SPS to request and obtain credit reports on my business in connection with the opening, monitoring, renewal and extension of this and other accounts with SPS. If I request, SPS will tell me whether my business credit report was requested and, if so, the name and address of the credit-reporting agency that furnished the report.
Authorized Signature for Credit Check *
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Authorization for Personal Guaranty

By signing this SPS application, I acknowledge that I have personally guaranteed the debts and obligations of my business and agree that I am personally obligated to perform all of the terms of and make all payments to SPS required by the agreement of which the application is a part.
Authorized Signature for Personal Guaranty
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Account Application - Updated 02-2019