APPLICATION FOR SERVICE

ACCOUNT INFORMATION

Name on account

Date of Birth

Social Security No.

Home Phone

Cell Phone

Co-Applicant name

Co-Applicant Social Security No.

Co-Applicant Date of Birth

Co-Applicant Cell Phone

Billing Address

Service Address

Email address

Co-Applicant Email address

Own

Rent

How long at this address

Landlord’s Name & Address

Prior address if less than 2 years at present

Place of Employment

Address

Years employed

Position

Work Phone

Co-Applicant Place of Employment

Co-Applicant Address

Co-Applicant Years employed

Co-Applicant Position

Co-Applicant Work Phone

TERMS OF AGREEMENT

The undersigned applies for an O. E. Meyer Co. open account and states that the information submitted is true and correct.
I authorize O. E. Meyer Co. to obtain information from EQUIFAX or any other additional source as necessary.

If an O. E. Meyer Co. open account is approved, I agree:

To pay billings to my account within 30 days of date on which the goods were delivered.
To pay O.E. Meyer Co. invoices with cash, checks, money orders, and or electronically (ACH). Credit card payments are accepted at the time of purchase or when the order is invoiced only.
To pay in advance for goods and services if credit terms are not established or denied.
To pay a 1.5% per month finance charge on overdue billings.

O. E. Meyer Co. reserves the right to decline further charges under this agreement at any time. This agreement may be terminated at any time by either O. E. Meyer Co. or the applicant, upon written notice to the other party’s last known address. Such termination does not affect any existing obligations of the undersigned, under this agreement. O. E. Meyer Co. reserves the right to change the terms of this agreement upon 30 days written notice.

Products purchased under this agreement are warranted to the extent of the warranty by the manufacturer. No additional guarantees or warranties shall be made by any O. E. Meyer Co. employee or agent unless written and signed by an office of O. E. Meyer Co. O. E. MEYER CO. EXPRESSLY EXCLUDES ANY WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.

Applicant's Signature**

Date**

** By typing your name electronically on this Form, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this Form. By Signing this form, you are verifying that you have read and understand the Policies Acknowledgement and Terms of Agreement

APPLICATION FOR SERVICE

ACCOUNT INFORMATION

TERMS OF AGREEMENT

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