Customer Information

The following information helps us improve our quality of service and ensures the accuracy of your information. Submitting this annually will help maintain discounted prices and deliveries. Thank you for shopping with us.

First Name

Last Name

Company Name

Address

Street Address

City

State

Country

Postal Code

Phone *

Email *

Website

Have You Purchased From Us Before? *

Yes

No

Preferred method for receiving future promotional information

Call

Text

Email

Preferred Language

Credit Card Authorization

Do you want your card on file? *

Yes

No

Credit Card Type

Visa

Mastercard

American Express

Discover

Card #:

Name on card:

Exp. Date:

CVC:

Billing Address is the same as the company address:

Yes

No

Billing Address

Billing Zip

Billing State/Region

Billing City

List up to 7 persons authorized to make purchases and arrange receipt of material for your company.

1
2
3
4
5
6
7

E-Signature for Credit Authorization

Clear

Attach a picture of your valid driver's license and the front/back of the credit card used to authenticate your identity.

Date

As a Preferred Buyer of materials from American Roofing Supply & Building Products, I hereby authorize American Roofing Supply & Building Products, Inc to retain my credit card information for us on current and future purchases. My signature authorizes American Roofing Supply & Building Products to make deliveries of material in my absence to the authorized materials receivers listed above. I also indicate understanding and acceptance of all terms, conditions, and personal guarantees described on Invoices, Sales Order Acknowledgments and/or Credit Applications.

I acknowledge this *

acknowledged

Captcha

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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