Cash On Delivery (COD) Account Application

To create a COD account with BR Supply, fill out the form below, and push the Submit button. You will be contacted when your account is created and ready for use.

REMINDER: This is NOT a request for a charge account. If you would like a charge account, please return to the Credit Application page, and complete either the Business or Personal Credit Application (whichever is applicable to you).

Account Name

Contact Name

Address

City

State

Zip Code

County

Phone

Cell Phone

Email Address

Fax

Is your account non-taxable? Yes No

If this account is non-taxable, attach your sales tax exemption form here:

I prefer to fax, mail, or drop off my tax exemption form.

Do you have an EPA certification?

Yes

If you have an EPA certification, attach a copy of your card here:

I prefer to fax, mail, or drop off a copy of my EPA certification.

Primary Store Location

Sales Rep (if any):

Additional Information

If you have questions, please contact our Credit Applications department:

Phone: 731-784-1895
Fax: 731-784-1811
Email: [email protected]

Cash On Delivery (COD) Account Application

BR SUPPLY

Useful LINKS

May we HELP YOU?

Contact INFO