Accounts | Phoenix Rose Fasteners

Credit App

Step 1 of 3

Company Name*
Name*
First Last
Phone*
Email
In Business Since:*
Please enter the year
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is this the same address for Shipping?*
- Yes
- No
Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Accounts Payable Contact*
First Last
Accounts Payable Phone*
Accounts Payable Email
If you wish to have your invoices sent to you by email, please enter the address where they should be sent.

Trade References
Company Name of Trade Reference*
Contact Name*
First Last
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone*
Company Fax
Do you have more references?*
- Yes
- No
Company Name of Second Trade Reference*
Contact Name of Second Trade Reference
First Last
Company Address of Second Trade Reference*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone of Second Trade Reference*
Company Fax of Second Trade Reference

Net 30 Terms

For your convenience, we offer Net 30 Term accounts for businesses, schools, and government agencies. Feel free to complete the application on this page and we will start the process of setting up an account for you!

The process typically is completed in 24 hours, but can be delayed while waiting for credit references to respond.

Prepay Accounts

If you are not comfortable with setting up a charge account, we can also offer you the option to prepay an amount and deduct from it each time you come in. We have customers who pay $500 to credit their account, and then use the credit to pay for purchases later on.

Auto Deduct

Some of our customers prefer having their credit card information on file and when an invoice is generated their credit card is immediately charged. Rest assured, if you choose this option, your credit card information is destroyed after entering it into our credit card processing system and the card number is hidden after entry. This option is nice for those who have credit cards with rewards! Give us a call and get set up today!

ACH Payment Option

Save money on checks and postage… pay your invoices using ACH.
Routing: 021052053
Acct: 33297165
Please send remittance info to:

Tax Exempt

You can download a copy of the Tax Exempt form for the state of Ohio here: TaxExemptForm

ONLY USE THIS BOX IF YOU ARE NOT FILLING OUT A CREDIT APP. There will be a place for you to attach your tax exempt form IN the app.

Step 1 of 3

Trade References

Net 30 Terms

Prepay Accounts

Auto Deduct

ACH Payment Option