New Customer Information Form

  • Company Name
    (if NO, copy of Florida Resale Certificate must be provided)

  • Person #1
  • Person #3
  • List Three Business References:
  • Reference #1
  • Reference #2
  • Reference #3
  • You are authorized to contact any of all of the above references regarding our credit standing. Further, you are authorized to check with outside sources such as Dunn & Bradstreet, TRW, etc. regarding our credit standing. I (we) have read the terms and conditions and agree to abide by them.

  • MM slash DD slash YYYY
  • In consideration of United Materials, Inc. extending credit to the above applicant, we the undersigned individuals, jointly and severally, as individuals, guarantee the payment of any and all future obligations of the above mentioned, which may be due and owing to United Materials, Inc., that this guarantee is continuing in nature and can only be terminated by mail and/or delivering written notice to United Materials, Inc. Individual guarantors herein further agree to pay upon demand all costs and expenses of collection including but not necessarily limited to collection fees and/or attorney fees sought for collection together with interest on the outstanding principal balance at the rate of 18% per annum or 1.5% per month on any and all invoices not paid in accordance with the terms therein.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Dear Valued Customer:

    Presently our company is in the process of updating its customer contact information. In order to make sure everyone in your company is receiving the most up to date information, please send us an updated list of names, title, and e-mail for the authorized personnel in your office, who should receive the following: (mark an X in one or more of the boxes)

    WP: Web Login
    OA: Order Acknowledgement
    OC: Order Cancellation
    I: Invoice
    P: Promotion / advertising

    We would really appreciate it if you could take a few minutes to fill out the following form and either fax it to 239-593-6996 or e-mail it to [email protected]

Forum Quartz is sold exclusively outside of Florida

I understand, Proceed


Pompeii Quartz is only sold in Florida

I understand, Proceed