Mister Plumber, Inc. radio dispatched 24-hour emergency service 7 days a week
553 Central Drive
Virginia Beach, VA 23454

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Customer Credit Application
Fill out form below or download form here and FAX back to (757) 460-2699.

* Date:
* Applicant's Name:
* Business Name:
* Business Address:
* Phone:
* Fax:
* Email:
* Type of Business:
* Years in Business:

* Is Applicant:

Individual Corporation
Proprietorship Partnership
* Customer Federal ID#:
Tax Exempt: Yes No
* Tax Exempt #:
* PO Number Required?: Yes No

Credit References:
Please fill this section out in full

* Name:
* Bank Address:
* Contact Name:
* Phone:
1) * Name:
* Address:
* Phone:
* Fax:



3) Name:


4) Name:


* Credit Amount applied for: $ PER MONTH **

* Principle Name:
* Address:
* Phone (home):
* Phone (cell):

* Person(s) Authorized to Request Service for this Customer:

I / We hereby authorize Mister Plumber, Inc. to obtain any credit or other information from whatever sources they may consider appropriate in order to establish and maintain a credit account in my/our name. I / We understand that all invoices are due and payable fifteen (15) days from date of invoice and personally agree to pay 1.5 % interest per month (18% per annum) or as otherwise specified from time to time on the invoices rendered, on amounts overdue, in addition to any collection, court and legal costs that may be incurred in order to collect amounts that may become delinquent hereunder in the amount of 33%. All returned checks are subject to $50 return fee.

I Agree*

* required fields


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