ABT, Inc. PO Box 837 259 Murdock Road Troutman, NC 28166 Fax: (704) 528-5478 (704) 528-9806 (800) 438-6057
Price Increase Announcement
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Required information must be entered in the form below. The additional requested information can be supplied either by entering into provided boxes or by attachment. Print the application after data entry, sign where indicated, and fax signed form and any attachments to ABT at (704) 528-5478.
Business operates as: Individual Partnership Corporation Other
If a corporation, incorporated in State of: select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Date of incorporation:
List any other states in which firm has been domesticated:
Payables Schedule: EOM Bi-Monthly Other:
Please attach sales tax exemption certificate and/or sales tax number:
Please read carefully
I (we) understand that the information furnished to you on this application for account is for the purpose of obtaining credit from your firm. I (we) further understand that your firm may at any time refuse to grant credit to me even though credit is initially granted pursuant to this application. I am (we are) authorized in (my/our) capacity, to bind (my/our) firm for any and all credit which you approve to us and to the terms and conditions set forth below with respect to any sales. It is further understood and agreed that all accounts or monies due ABT, Inc. shall be due and payable at its office in Troutman, N.C. All sales made and credit extended are governed by the following:
Must be signed by owner, officer, partner or other authorized individual only.
Signature: ___________________________________________________
All information will be held in confidence by our Credit Department.
© 1998–2008 — ABT, Inc.