Credit Information Statement – American Backflow Products Company

Skip to content

(800) 575-9618
(0) Total:$0.00

Live Chat Now
Account Log In

Place Order
Repair Help
My account

Home
Repair Parts
- Ames
- Apollo / Conbraco
- ARI
- Beeco
- Cla-Val
- Deringer
- Febco
- Flomatic
- Hersey
- Rain Bird
- Watts
- Wilkins
Complete Assemblies
- Ames
- Apollo / Conbraco
- ARI
- Beeco
- Febco
- Watts
- Wilkins
Specialty Tools
- Ames
- Apollo / Conbraco
- Febco
- Flomatic
- Watts
- Wilkins
- Universal
Testing Equipment
Enclosures & Cages
Shutoff Valves
Accessories
Control Valves
- Ames
- Apollo/Conbraco
- Bermad
- Cla-Val
- Flomatic
- OCV
- Singer
- Watts
- Zurn/Wilkins

Repair Videos
Repair Procedures
Phone Support

Dashboard
Shopping Cart

Find Your Part Now

Credit Information Statement

Business Name*
Mailing Address*
City/State/Zip*
Street Address
City/State/Zip*
Tel. No.*
Fax No.
Type of Business
Person Responsible for Purchasing
Email
This business is a
- Corporation
- Co-partnership
- Limited Partnership
- Proprietorship
We have been established below years under the above name
At present location since
Does your company use purchase orders?
- Yes
- No
Does your company have a valid resale certificate?
- Yes
- No
If "Yes", please attach copy of certificate
The principle owners or officers are:
Name
Position
Address
City
Phone
Our 3 major sources of supply with whom we have open accounts are
Name
Address
City
Phone
Fax
List all Bank References
(Bank)
(Address)
(Account No.)
(Phone)
Have you ever filed bankruptcy?
- Yes
- No
* If "Yes", please state detail
We Expect Our Monthly Credit Requirements To Be Approximately
I/We understand that all information provided herein is correct and is for the purpose of obtaining credit and such information will be handled in confidence. Terms of payment are Net 30 days. Credit hold after 45 days. The undersigned has read and agrees to the payment terms and conditions of this firm.*
- Yes
Printed Name of Owner or Owner ONLY

Customer Service

Meet Our Staff
Contact Us
Calibrate Your Test Kit
Order Tracking
Chat With A Pro
Satisfaction Survey

Repair Info

Repair Videos
Step By Step Repair Procedures
Backflow Test Procedures
Backflow Lay Length Chart
Repair Guys Articles

Links

Training Schools
Professional Associations
ABPA Chapters
USC Backflow Approvals
ASSE Backflow Approvals
IAPMO
Manufacturer Websites
Backflow News

Forms

Credit Application
Custom Order Form
Return Form
Manufacturer Price Lists (MSRP)

Follow Us

Facebook
Google+
Linkedin

Copyright © 2018 American Backflow. All rights reserved.

Save & Share Cart

Your Shopping Cart will be saved and you'll be given a link. You, or anyone with the link, can use it to retrieve your Cart at any time.

Cart Name

Redirect To

Save Cart & Generate Link

Send Cart in an Email Done! close

Empty cart. Please add products before saving :)

Back Email Cart

Your Shopping Cart will be saved with Product pictures and information, and Cart Totals. Then send it to yourself, or a friend, with a link to retrieve it at any time.

To

From Name

Subject

Send Cart Email

Your cart email sent successfully :)

Billing Addresses

Fields are required having (*).

Select Address:

First Name: *: Please enter your first name

Last Name: * Please enter your last name

Company Name:

Email: * Please enter your email

Phone:

Address * Please enter your address

Country * Please select your country

City * Please enter your city

State * Please select your state

Zipcode * Please enter your zip

Mark this billing method as default

Shipping Addresses

Fields are required having (*).

Select Address:

First Name: *

Last Name: *

Company Name:

Address *

Country *

City *

State *

Zipcode *

Mark this shipping method as default

Email Order

Email address:

From Name:

Subject:

Your Message:

Send

Email Sent Sucessfully !

Login / Registration

Log In

Customer Login

Need an account? Choose from below:

Backflow Tester or Contractor

Click here

Home Owner

Click here

Login / Registration

Customer Login

Login or Register

Customer Login

Don't have an account

Choose below

Backflow Tester/Contractor Home Owner

Backflow Tester Or Contractor Log In

*