Company Name

Street Address

City             State Indiana Michigan Illinois                Zip Code

Company Website

Is this Account to be tax exempt? Yes No                 If Yes, your tax exempt #

Years at Present Address?                   Bank Officer Contact

Bank Name           Bank Phone #

Purchasing Contact     Purchasing Phone

Purchasing Fax            Purchasing Email 

Receiving Hours, Indicate closed lunches:

Special Instructions for our drivers

Accounts Payable Contact    Accts Pay Phone

Accts Pay Fax             Accts Pay Email

Tepe prefers to electronically send invoices to Accounts Payable Contact, your preference? Fax Email Snail Mail

Tepe will send statements for open balances, your preference? Email to Purchasing Contact Fax to Purchasing Contact Fax to Accounts Payable Snail Mail Email to Accounts Payable

Tepe also excepts Visa and MasterCard, please select the method of payment you are requesting? Visa C.O.D. Mastercard Net 30

We need THREE Business References: Provide Business Name, Contact, Fax # (if Fax is not available full address and phone#)

Reference 1

Reference 2

Reference 3

I agree to pay interest of 1½ % per month on balances over 30 days.  I also agree to pay reasonable costs of collection and attorney fees if the account becomes delinquent to the point that these actions need to be taken.   
 I agree   I disagree  (If you disagree then the account can only be setup as C.O.D., Visa or MasterCard)

Signature