New Account Credit Application Business Information:How did you hear about us? Online or Print Ad Friend/family/colleague Aetna Representative Other: Aetna Sales Rep you are currently working with (if applicable)Other:Preferred Aetna Branch(Required) Maywood, IL Lexington, KY Indianapolis, IN Rockford,IL White Bear Lake, MN Legal Name of Business:(Required)Business Type(Required) Proprietorship Corporation Partnership Limited Liability Corp. LLC Do you have a Company website?(Required) Yes No Company WebsiteYears in Business(Required)How many Employees do you have?(Required) 0-10 10-50 50-100 100+ Do you have a Federal Identification Number (FEIN)?(Required) Yes No Federal Identification Number (FEIN)(Required)Business Tax Status(Required) Taxable Tax Exempt (tax exempt certificate required) Tax Exempt CertificateAccepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.jpg, gif, png, pdf file types allowedHave you previously done business with Aetna Building Solutions?(Required) Yes No If yes, account number or last purchaseBusiness/Market details (Check all that apply)Primary Business Market(Required) Acoustical Ceiling & Drywall Arch. Millwork Architect Closets Countertop Manuf. Designer Door/Window Manuf. Exhibit Manuf. Furniture Manuf. Games Hardwood Ply. Manuf. Home Builder Home Center/ Retail Lumber Hospitality Carp./ Maint. Shop Kitchen & Bath Cab. Manuf. Office Furn. Manuf. School Carp./Maint. Shop Signs Stone Fabricator Store Fixture. Market Segments(Required) Healthcare Education Food Service Retail Lodging/Hospitality Commercial Interiors Multi-Family Other Other Market Segments:Product Interests(Required) Lumber Plywood HPL/TFL MDF/Particleboard Hardware Adhesives Solid Surface Quartz Fabrication Services Other Other Product Interests:Current Suppliers:(Required)Supplier 1Supplier 2Supplier 3 Add RemoveIf you have no suppliers currently, type N/A.Products:(Required)Product 1Product 2Product 3 Add Remove$ Per Month:(Required)Amount #1Amount #2Amount #3 Add RemovePending Order?(Required) Yes No Approx. $ Value:(Required)Bill ToBill To Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Main Phone(Required)FaxEmail Address for Invoices/Statements(Required) Enter Email Confirm Email Ship To:Is your 'Ship To' address different than your 'Bill To' address?(Required) Yes No Ship To Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nearby major intersecting streets, highways or roads:Do you require purchase order #'s to appear on your invoices?(Required) Yes No Do you require order acknowledgements?(Required) Yes No Do you prefer COD terms?(Required) Yes No Delivery Details (check all that apply):Delivery type(Required) Dock Lift Side Forklift Tractor/Trailer Accessible Hand Unload Will Call Only Receiving Hours:(Required)Obstacles to Delivery(Required) Residential Trees or Low Wires Weight Limits Posted Roads Inability to turn around Fork Truck Weight Capacity None Other Other:Contact Information(1) Buyer Name(Required)(1) Buyer Email(Required) (1) Buyer Phone(Required)(2) Buyer Name(2) Buyer Email (2) Buyer Phone(1) Project Manager Name(1) Project Manager 1 Email (1) Project Manager Phone(2) Project Manager Name(2) Project Manager Email (2) Project Manager Phone(1) Accounting Name(Required)(1) Accounting Email(Required) (1) Accounting Phone(Required)(2) Accounting Name(2) Accounting Email (2) Accounting PhoneOwners/Partners/Corporate Officers(1) Name and Title(Required)(1) Mobile Phone(Required)(1) Email(Required) (2) Name and Title(2) Mobile Phone(2) Email Trade ReferencesCredit Trade References: Surfaces, Composites, Plywood, Hardware, Lumber & Other (Three references are required for this form to be submitted) Reference 1 - Business Name(Required)Reference 1 - Contact(Required)Reference 1 - Phone Number(Required)Reference 1 - Email(Required) Reference 1 - Monthly $ Purchases(Required)Reference 1 - Product(Required)Reference 2 - Business Name(Required)Reference 2 - Contact(Required)Reference 2 - Phone Number(Required)Reference 2 - Email(Required) Reference 2 - Monthly $ Purchases(Required)Reference 2 - Product(Required)Reference 3 - Business Name(Required)Reference 3 - Contact(Required)Reference 3 - Phone Number(Required)Reference 3 - Email(Required) Reference 3 - Monthly $ Purchases(Required)Reference 3 - Product(Required)Personal GuarantyPersonal Guaranty(Required)The undersigned hereby personally guarantees any existing or hereinafter created indebtedness by the Applicant to Aetna Building Solutions, Inc., and waives presentment and demand for payment, notice of payment, notice of non-payment, protest and notice of protest, and consents without notice of any extensions of time or increase in the amount of credit given. This is intended to be a continuing guarantee and shall continue as to all new indebtedness incurred unless and until a written notice is served upon Aetna Building Solutions, Inc. by certified mail-return requested; declaring said personal guarantee shall not apply to the future purchases. Guarantor consents to allow Aetna Building Solutions Inc. to change or modify the terms of sale without notice to or authorization of the guarantor. Guarantor assumes all responsibility for staying advised as to the Applicant's financial condition and risk. I agree to the personal guaranty.(Required)Personal Guaranty Signature(Required)Print Your Name (as used above)(Required) First Middle Last Agreement For A Commercial AccountAgreement for a Commercial Account(Required)Applicant hereby applies to Aetna Building Solutions, Inc. ("Aetna") to open a commercial account in Applicant's name and hereby requests Aetna from time to time to extend credit to enable Applicant to buy merchandise from Aetna for business or commercial purposes only. As an inducement to Aetna to extend credit, and in consideration of Aetna agreeing to extend credit to Applicant, Applicant states as follows: 1. Applicant represents and warrants that all information including but not limited to the information on the Application for Credit, given in connection with this Application and Agreement ("Agreement") is true and correct as of the date of this application. Applicant agrees to provide Aetna with notice of changes to the information contained on the face and back of this agreement as they occur. 2. Applicant agrees to pay within thirty days of the date of the invoice for all merchandise delivered on that invoice. ("Payment Due Date") 3. If any invoice remains unpaid after the Payment Due Date then Aetna has the right to not deliver further orders and need not notify Applicant. 4. If any amount due for any merchandise remains unpaid on the last business day of the month in which Payment Due Date falls, Applicant shall pay to Aetna a late charge on all past due amounts from the first day of the month immediately following the month in which the Payment Due Date falls until such amounts are paid in full. 5. The late charge shall be two percent per month, equaling an annual percentage rate of twenty-four percent. 6. If Applicant pays any invoice with a check, and the check is returned from Applicant's bank unpaid for any reason, Applicant will pay a service charge of thirty-five dollars or one half of one percent of the face amount of the check, whichever, is greater. The service charge will be along with any late charges that may be applicable. 7. Applicant agrees that any merchandise to be returned, if approved by Aetna, Applicant will incur a restocking charge and further responsibility for shipping and handling charges. 8. This agreement shall be a continuing agreement and shall apply to each purchase of merchandise. Applicant agrees that Aetna can change or amend any of the terms on this Agreement. Applicant's continued use of commercial charge account after the effective date of the amendment or change shall be deemed acceptance of the changed terms. 9. Applicant may terminate this Agreement at will at any time by written notice to Aetna. Such termination to be effective following the receipt of the notice. Termination of this Agreement shall result in all subsequent purchases being shipped on prepaid basis only. 10. Applicant agrees to hold harmless Aetna Building Solutions, Inc. for any damages resulting from the withholding and/or delaying of the shipment of merchandise to Applicant resulting from events outside the control of Aetna Building Solutions, Inc. 11. Applicant understands and agrees that Aetna's liability of damages as a result of failure of any product shall be limited to the cost of replacement of the goods supplied, and Aetna shall not be label for any incidental or consequential damages arising therefrom. 12. Applicant agrees to submit to the jurisdiction of the Circuit Court of Cook County, Illinois. 13. Applicant and Aetna hereby waive the right to a jury trial for any claim arising from the enforcement of this agreement. 14. Applicant will pay all expenses, including reasonable attorneys' fees, incurred by Aetna in the enforcement of this agreement and the collection of any charges due thereunder. 15. Aetna's failure to exercise any of its rights hereunder shall not be deemed a waiver of Aetna's rights under this agreement. The Applicant, whose signature appears below, ("Applicant") hereby authorizes Aetna to request and to obtain credit information from Applicant's trade, bank and personal references. Applicant authorizes the references contacted by Aetna to release to Aetna the information concerning the status and conduct of the Applicant's business and personal credit. Applicant will be charged 2% credit card processing fee if a credit card is used to purchase material. Aetna does not accept American Express. The undersigned hereby consents to Aetna Building Solutions, Inc.'s use of non-business/business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as a principal, proprietor, partner and/or guarantor in connection with the extension of the business credit as contemplated by this credit application. The undersigned hereby authorizes Aetna Building Solutions Inc. to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by the credit application. The undersigned as an individual hereby knowingly consents to the use of such credit report consistent with the Federal Fair Credit Reporting Act. I agree to the agreement for a commercial account.(Required)Commercial Account Signature(Required)Print Your Name (as used above)(Required) First Middle Last CAPTCHACommentsThis field is for validation purposes and should be left unchanged.