Ventra Supply

01Business Information

Legal Business Name*

DBA / Trade Name

Business Entity Type*

Year Established*

Number of Employees

02EPA Certification

EPA Section 608 Certification #*

EPA Certification Type*

03Contact & Location

Physical / Business Address*

City*

State*

Zip Code*

County / Primary Service Territory

Mailing Address (if different)

Main Phone*

Fax

Business Email*

Website

04Key Contacts

Owner / Principal Name*

Owner Mobile / Direct Line

Accounts Payable Contact*

AP Phone / Email*

Primary Purchasing Contact*

Purchasing Email*

Authorized Buyers / Employees Permitted to Purchase on Account

05Business Profile

Current Primary Distributor(s)

How Did You Hear About Us?

06Payment Terms

07Account Preferences

Preferred Order Method

Email POIn Person at Counter

Invoice / Statement Delivery

EmailMail

Email Address for Invoices*

Additional Notes / Special Requirements

08Terms, Conditions & Authorization

Credit Agreement: By submitting this application, the applicant authorizes Ventra Supply, LLC to investigate credit history through trade references and credit reporting agencies. Applicant agrees to pay all invoices per the agreed payment terms. Past-due balances may accrue a finance charge of 1.5% per month (18% APR). Applicant is responsible for all costs of collection, including reasonable attorney's fees.

Personal Guarantee: The undersigned owner/principal personally guarantees unconditional payment of all amounts owed by the business entity named herein. This guarantee remains in effect until written notice of cancellation is received by Ventra Supply, LLC.

Return & Restocking Policy: Returns must be initiated within 30 days of invoice date with original receipt. Special-order items, refrigerants, and electrical components are non-returnable. A restocking fee of up to 25% may apply. No equipment returns without prior written authorization.

Liability Limitation: Ventra Supply, LLC shall not be liable for any delays due to causes beyond its reasonable control. The purchaser assumes full responsibility for the correct selection and application of materials. All product warranties are those provided by the manufacturer only.

Data & Privacy: Information provided on this application will be used solely to establish and manage your trade account and for credit verification. It will not be sold or disclosed to third parties except as required by law or necessary for credit processing.

Account Modifications: Ventra Supply, LLC reserves the right to adjust credit limits, payment terms, or account status at any time based on payment history, credit review, or business circumstances.

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

Printed Name*

Title*

Date*

Signature*

By typing your name above as your signature, you confirm all information is accurate and you have authority to bind the business.

Documents to Include with Application

EPA Section 608 Certificate (required)
W-9 Form (for net-terms accounts)
Voided Check (if requesting ACH/EFT payment setup)

EPA Section 608 Certificate*

Choose file

W-9 Form

Only needed if requesting net-terms.

Choose file

Voided Check

Only needed if requesting ACH/EFT payment setup.

Choose file