New Customer – Credit Application

Customer Registration Form – Credit

  • Business Information

  • Permittee Information


  • Emails


  • Accounts Payable


  • Backer Information


  • Credit Reference


  • Bank Reference

  • Terms

    1. It is agreed and understood that the terms of the sale shall be as determined by the Credit Department, and that this constitutes a commercial transaction.

    2. It is further agreed that if said account is turned over for collection, finance charges at 1.5% per month, reasonable attorney’s fees and/or costs of collection shall be added to the unpaid balance, whether or not legal action is instituted.

    3. The undersigned does hereby voluntarily and knowingly waive his or her right to a notice and hearing under Sec. 52-278a to 52-278g inclusive of the Connecticut General statutes so that in any action upon a commercial transaction commenced by Hartford Distributors, Inc. against the undersigned, Hartford Distributors, Inc. may obtain an ex parte prejudgment remedy (attachment, garnishment and/or replevy, etc., as defined in said Statutes).

    4. In consideration of opening an account in the name of the Company, I, undersigned, hereby individually guaranty all obligations of the account, agree to be bound by the terms and conditions of the application and credit agreement, authorize Hartford Distributors, Inc., to bill the Company directly, and I shall continue to be obligated until such time as I receive a release from personal liability in writing from Hartford Distributors, Inc. This obligation shall be my personal obligation, jointly and severally with the Company and any person and/or entity who is also obligated. In addition, even if my title is stated above or below, it is the intention that I am personally liable in my individual capacity for all obligations to Hartford Distributors, Inc., including all collection costs, finance charges at 1.5% per month and all reasonable attorney’s fees for Hartford Distributors, Inc. This agreement shall be for the benefit of Hartford Distributors, Inc. and all affiliated and related entities, as well as its successors and assigns.

    5. By submitting this application, the undersigned understands and acknowledges that Hartford Distriibutors, Inc. may request and obtain a consumer credit report on the applicant at any given time to determine ability to honor this guarantee.

  • Signature

    A verification email will be sent to the email address provided below. Your response is required for completion of this application.

    A representative from Hartford Distributors, Inc. will also contact you directly at the phone number provided to collect your Social Security Number and Federal ID Number.

  • (Owner, Partner or Corporate Officer)
  • MM slash DD slash YYYY
  • Hidden
  • Verification