Name of Property/Facility: *
Property Owner: †
† The owner of the property/facility is the applicant (the "Applicant") under this Credit Agreement and is the primary obligor hereunder.
Do you use a vendor compliance platform? (Compliance Depot, Notivus, Net Vendor, RMIS, etc.)
Name: *
Title *
Phone *
Fax
Email *
Site Address *
Name:
Title
Phone
Email
Management Co: *
Manager: *
Phone:
Fax:
Email:
Maint. Director:
Regional Manager:
Management Co. represents and warrants that it is acting as appointed agent of the Applicant.
Please specify names: *
Do you require Purchase Orders? * Yes No
If yes, please check one: Verbal P.O.s acceptable Written P.O.s required
Applicant represents and warrants that any products containing CFCs or HCFCs (including R22 and R410A) will be handled by a technician with a valid EPA Certificate (and in Miami-Dade, a DERM Permit). Please attach a copy of the relevant certificates and permits and identify the name(s) of this/these technician(s):
Applicant hereby agrees to the attached Terms & Conditions. To Sign, full out your full name and title below:
Full Name: *
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