CHBriggs

Online Credit Card Only Application

You will receive a username and password via email within the next business day, Monday through Friday 7:30am - 5:00pm EST. Please complete all fields before submitting this application. Thank you.

How did you hear about C.H. Briggs?

If other, specify:

Please send me the following catalog(s):
C.H. Briggs Full-Line Catalog (The Big Green Book)
C.H. Briggs Mini Green Book (Electronic Version)
Briggs Collection Catalog (Decorative Hardware)
3M Custom Woodworking Catalog (Abrasives & Adhesives)
Amerock (Decorative Hardware)
BLANCO (Sinks)
Classic Brass (Decorative Hardware)
Doellken - Woodtape Stock Program & Laminate Cross Reference Guide
Fast Cap (Wookworking Tools)
Grass (Hinges & Slides)
Hickory Hardware In-Stock Offering Catalog (Decorative Hardware)
KV (Slides)
Pionite (Decorative Surfaces)
Rev-A-Shelf (Cabinet Convenience Items)
Salice (Hinges)
Schaub & Company (Decorative Hardware)

First Name:

Last Name:

Company:

How will your www.chbriggs.com registration assist you as it relates to your position in your organization?
Look up products, check pricing & product availability
Purchase products
Both

Phone:

Fax:

Email:
*required

Yes No Would you like to receive via email shipping notifications? (Currently for UPS Only)

Accounts Payable Contact:	Email:	Fax:

Email Fax US Mail How would you prefer to receive your invoices?

Tax ID#: (EIN#)
None
(If no Tax ID# is entered you will be contacted to provide a voided business check)

SIC Code#:
Not Known

Credit Card Billing Address

Address 1:

Address 2:

Address 3:

City:

State: County:

Zip:

Ship to the same address?

Note: State sales tax will be charged unless a signed resale exemption form is returned. Applicable states: AL, FL, DC, GA, MD, MI, NC, NJ, NY, OH, PA, SC, TN, VA. A physical copy of your tax exemption certificate must be provided. This can be faxed to our credit department at 610-921-4834 or mailed to our credit department at C.H. Briggs Company, P.O. Box 15188, Reading, PA 19612-5188.

* No P.O. Box Allowed in Shipping Address
Shipping Address 1:

Shipping Address 2:

Shipping Address 3:

City:

State: County:

Zip:

Has applicant or any of its principals ever filed a voluntary petition in Bankruptcy?
Yes No

Terms: In consideration of C.H. Briggs extending credit to the Applicant, the Applicant agrees to pay for all items delivered or services rendered to, or at the request of, the Applicant, in accordance with the terms of each invoice. Applicant agrees that each of the terms and conditions of sale stated on the invoices shall be a term of the contract of each sale from C.H. Briggs to the Applicant. Applicant acknowledges that a monthly service charge of the highest amount legally allowed in the state shall be made on all sums due C.H. Briggs which have not been paid by the 30th day of the month following billing, and Applicant agrees to promptly pay said service charge. An additional service charge, computed on the same basis, will be due and payable every thirty (30) days thereafter. Waiver of any one or more service charges shall not be deemed to be a waiver of future service charges. Applicant further agrees that with regard to such service charges, Applicant and C.H. Briggs are parties to a written commercial contract. Should it become necessary to place the account with a collection agency or attorney, the Applicant agrees to pay all collection costs and attorney fees in addition to all other sums due. Applicant authorizes C.H. Briggs to obtain credit and financial information concerning the Applicant at any time and from any source. The undersigned warrants that the above agreement has been carefully read and that Applicant understands completely. Applicant also warrants that all information provided is true and correct.

I Agree:
Yes No

Thank you for your interest in C.H. Briggs. In an effort to make your experience with us more relevant, please take a moment to fill out a short questionnaire (1-2 minutes). All information gathered is for internal purposes only. Please click on the "Submit" button to complete the survey and process your Credit Card Only Account request.

C.H. Briggs Company

P.O. Box 15188

- Reading, PA - 19612-5188 -

1.800.355.1000

fax:1.800.355.3131

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