Online Credit Application



Please fill out and submit the form below to be considered for NET 30 Terms. If you have questions, contact our Accounts Receivable team at

(800) 344-0150   -




Enter as many addresses as apply to you



Please review the information you have detailed above before signing.

By entering your NAME and DATE SIGNED below, you are certifying that all information on this form is correct and that you fully understand U.S. Hose & Coupling's credit terms and agree to proper payment in consideration of extended credit. TERMS: 1% 10 Net 30 unless agreed upon by both parties.


Please fill out the sales tax exemption form if applicable, otherwise the appropriate sales tax will be charged to all invoices. If you have your own Tax Exemption form, you may upload it using the file uploader located at the end of this form instead.
The purchaser listed above ("Vendor") hereby claims exception or exemption on all purchases of tangible personal property and selected services made under this certificate. The Vendor also certifies that the claim is based upon the purchaser's proposed use of the items or services, the activity of the purchase, or both, as listed below:
Purchaser must state a valid reason for claiming exception or exemption
By entering your NAME above and DATE SIGNED below, you are certifying that all information on this Tax Exemption form is correct.
Vendors of motor vehicles, titled watercraft and titled outboard motors may use this certificate to purchase these items under the "resale" exception. Otherwise, purchaser must comply with either rule 5703-9-10 or 5703-9-25 of the Administrative Code. This certificate cannot be used by construction contractors to purchase material for incorporation into real property under an exempt construction contract. Construction contractors must comply with rule 5703-9-14 of the Administrative Code.
Click or drag a file to this area to upload.
FILE TYPES ALLOWED: .pdf, .doc, .docx, .jpg