Company Name:              Number of Years in Business:

Type of Business:                         Phone: Fax:

Purchasing Contact:            Phone: Fax:
           Email Address:

Accounts Payable Contact:Phone: Fax:
           Email Address:

 Bill to address:       

                        City:   State:   Zip: Country:

D&B #:               Other Email Address:

Ship to address:

                      City:   State:   Zip:   Country:

Home Office

Address:      Phone:  Fax:

        City:   State:   Zip:   Country:

 Credit Information:

Bank Name:         Contact:

Bank Address:     Phone: 

                      City:   State:   Zip:    Country:

Please Provide Four Credit References:

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

Company:         Contact:

        Phone:  Fax::

ALL CREDIT INFORMATION SUPPLIED WILL BE KEPT CONFIDENTIAL

Please note that as an added service we accept the following major credit cards:
                                                American Express, Visa and Master Card

Tax Information   (Exemptions)

                               State: ? Yes No NA          County or Parish: ? Yes No NA                           City: ? Yes No NA         

NOTE: If exempt, please furnish us a copy of your tax certificate for our records.

Our Remit to address is:  Piping and Equipment, Inc.
                                               P.O. Box 644297
                                               Pittsburgh, PA  15264-4297  

Please Note:  When you press the "Submit Form" button, this application will be sent via email to our corporate headquarters and will be kept strictly confidential.  You will be notified within 24 to 48 hours after this application is received.

Thank you for taking the time to set up an account with our company.  We are excited about this opportunity to do business with you!

Amount of Credit Line Requested:

Please enter your email address:

Credit Agreement

I have completed the above credit application for the purpose of obtaining credit from Piping and Equipment, Inc.. I understand that their terms are Net Thirty (30) Days and if my firm's tax exemption certificate is not attached, applicable state and local taxes will be charged. By submitting this form, I hereby authorize Piping and Equipment, Inc. to contact any of the references listed above in connection with their investigation of my credit worthiness, and I further authorize the above credit references to release information about my business relationships with them to Piping and Equipment, Inc. at any time. Applicant agrees to reimburse all costs associated with collecting past due balances, including but not limited to attorney fees, whether suit be brought or not. Applicant expressly agrees that regardless of place of payment, the terms of this agreement shall be governed by the laws of Florida and the parties agree to submit to the jurisdiction of Florida. By submitting this form, applicant warrants the above agreement has been carefully read and the applicant understands same.

  F-040 Rev.7    3/10/2009