Business Credit Application

Please complete this application in full. Approved accounts are extended credit under the Net 7, Net 15, or Net 30 payment terms selected below (payment due in full within the selected number of days from the invoice date), subject to the Terms & Conditions below and to credit approval by Sewer Cleaning Company. Required fields are marked with an asterisk.

Business Information

Legal Business Name *

DBA / Trade Name (if different)

Billing Address *

City *

State *

ZIP *

Physical Address (if different from billing)

Phone *

Fax

Email *

Website

Federal Tax ID / EIN *

Years in Business *

Business Type *

State of Incorporation

Owner / Officer Information

Owner / Officer Name *

Title *

Home Address

Phone

Accounts Payable Contact *

AP Phone / Email *

Credit Requested

Terms Requested (select one) *

Net 7 Net 15 Net 30

Amount of Credit Requested *

Anticipated Monthly Volume

Trade References

Three trade references are required. Please list companies that currently extend your business credit.

Trade Reference 1

Company Name *

Address / City / State *

Phone *

Account #

Trade Reference 2

Company Name *

Address / City / State *

Phone *

Account #

Trade Reference 3

Company Name *

Address / City / State *

Phone *

Account #

Bank Reference

Bank Name *

Branch / City *

Account #

Bank Phone / Contact *

Backup Payment Method (Card on File)

As a condition of credit approval, Applicant agrees to keep a valid credit card on file. This card will not be charged as part of normal billing, and will only be charged if an invoice becomes past due (unpaid beyond the Net 7, Net 15, or Net 30 term assigned by Sewer Cleaning Company), as authorized under the Terms & Conditions below.

How your card is collected. Once your application is approved, we send you a secure link by email or text to add your card to our payment system. It takes about a minute. Your card details go straight to our payment processor — they are never typed into this page, never sent by email, and never kept in our files.

I agree to place a valid credit card on file through the secure link sent to me after approval, and I authorize Sewer Cleaning Company to charge that card only for amounts that remain unpaid beyond the agreed payment terms, including any applicable late fees and collection costs described below. This authorization remains in effect until the account is closed or written revocation is received. *

Terms & Conditions

Applicant may request Net 7, Net 15, or Net 30 payment terms as indicated in the Credit Requested section above. Payment is due in full within the number of days specified by the term assigned, measured from the invoice date. The specific term granted is at the sole discretion of Sewer Cleaning Company based on its credit review and will be confirmed in writing on approval. Credit approval may be revoked or modified at any time.
A finance charge of 1.5% per month (18% annually), or the maximum rate permitted by law, will be applied to all past-due balances.
Applicant agrees to pay all reasonable costs of collection, including attorney's fees and court costs, incurred in collecting past-due amounts.
Sewer Cleaning Company reserves the right to withhold services, place the account on credit hold, or require payment in advance if the account becomes past due.
The undersigned certifies that the information provided in this application is true and accurate, and authorizes Sewer Cleaning Company to obtain credit and bank reports and to contact the trade and bank references listed above.
By signing below, the undersigned individual personally guarantees payment of all amounts owed to Sewer Cleaning Company by the business named in this application in the event the business fails to pay as agreed.
The credit card provided as a backup payment method will not be charged for on-time payments. If an invoice is not paid within the assigned Net 7, Net 15, or Net 30 term, Sewer Cleaning Company is authorized to charge the card on file for the outstanding balance, plus any applicable finance charges and collection costs.

I have read and agree to the Terms & Conditions above. *

I understand and accept the personal guarantee described in paragraph 6, and I personally guarantee payment of all amounts owed to Sewer Cleaning Company by the business named in this application. *

Authorization & Signature

Print Name *

Title *

Electronic Signature * Typing your name above constitutes your legal electronic signature.

Date *

By submitting, you agree to our Terms of Use and acknowledge our Privacy Policy.

Submitting this application does not guarantee approval. Credit is extended at the sole discretion of Sewer Cleaning Company.

How Approval Works

Submit This Application

We Review Your Credit

Account Opens

Business Information

Owner / Officer Information

Credit Requested

Trade References

Trade Reference 1

Trade Reference 2

Trade Reference 3

Bank Reference

Backup Payment Method (Card on File)

Terms & Conditions

Authorization & Signature