Purchaser's Agreement - Simplex Homes

Purchaser's Application

Step 1 of 6 - Builder Information

Welcome to the Simplex Industries, Inc. Purchaser's Application

This Purchaser's Application is for purchasers wishing to do business with Simplex Industries, Inc.. The application will take only a few minutes to complete but will require information that you should have ready. Some of this will include financial, banking and trade reference information.

Should you wish to begin the form and "Save and Continue Later", make sure to click that option on the bottom of the page, otherwise your information will be deleted and you will have to begin the application from the start when you return.

* = requred
Company Name*
Builders License Number (is applicable)
NOTE:Builders Licenses are required for the following states: MD, ME, RI and MA. If you build in one of these states you must attach a copy of your builders license to become an approved builder of Simplex
File
Accepted file types: jpg, png, pdf.
Contact Person Name*
Contact Person's Title*
Fed-ID or Social Security Number*
Company Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address*
Same as Company Address

Street Address Address Line 2 City State ZIP Code
Type of Business*
- Individual
- Partnership
- Corporation
- Other
Cell Phone Number*
Business Phone Number
Fax-Number
Years-in-business*
Below you will need to enter the Principal's email address. Please note that this address will need to be verified once you have submitted this application. If you are not the Principal, please make sure they are aware that they will receive an email asking them to confirm this email address. Application reviews require this confirmation.
Principal's email-address*

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The above named wishes to purchase homes from Simplex Industries, Inc. and has listed your Bank as a Bank reference and has authorized us to contact you. Please provide the following information.
Principal Bank Name*
Principal Bank Phone*
Principal Bank Contact Name*
First Last
Principal Bank Address*
Street Address Address Line 2 City State ZIP Code
Credit Verification For:*
Checking Account Number
Checking Account Average Balance
Do you have a Line of Credit?*
- Yes
- No
Authorization*
- I hereby authorize Simplex Industries Inc. to do a background credit check concerning the above mentioned company.
Preferred method of payment*
- COD (Bank Cashiers Check on Delivery)
- Wire/Electronic Transfer (Prepayment)

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Trade Reference 1 Company Name*
Trade Reference 1 Contact Name*
First Last
Trade Reference 1 Address*
Street Address Address Line 2 City State ZIP Code
Trade Reference 1 Phone*
How long have you been doing business with Trade Reference 1*
Second Trade Reference Information
Trade Reference 2 Company
Trade Reference 2 Contact
First Last
Trade Reference 2 Address
Street Address Address Line 2 City State ZIP Code
Trade Reference 2 Phone
How long have you been doing business with Trade Reference 2

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Will you furnish a recent financial statement?*
- Yes
- No

Save and Continue Later

Adobe PDF Reader Needed

The following documents are available in PDF format. If you do not have Adobe PDF Reader, click here to download a free copy of this program
DELIVERY CONFIRMATION document*
- Delivery Confirmation - ACCEPTED
ACKNOWLEDGEMENT OF TERMS By checking this box you acknowledge and accept that you have read and agree to the terms of the attached Simplex “Document”( Delivery Confirmation ). Additionally, the contents of this “Document” are referenced and incorporated into the Simplex Sales Contract.
GENERAL INFORMATION & POLICIES document*
- General Information & Policies - ACCEPTED
ACKNOWLEDGEMENT OF TERMS By checking this box you acknowledge and accept that you have read and agree to the terms of the attached Simplex “Document”( General Information & Policies ). Additionally, the contents of this “Document” are referenced and incorporated into the Simplex Sales Contract.
SIMPLEX INDUSTRIES BUILDER/PURCHASER RESPONSIBILITIES document*
- Simplex Industries Builders/Purchaser Responsibilities Document - ACCEPTED
ACKNOWLEDGEMENT OF TERMS By checking this box you acknowledge and accept that you have read and agree to the terms of the attached Simplex “Document”( Simplex Industries Builder/Purchaser Responsibilities ). Additionally, the contents of this “Document” are referenced and incorporated into the Simplex Sales Contract.
RETAIL ACKNOWLEDGEMENT document*
- Retail Acknowledgement - ACCEPTED
ACKNOWLEDGEMENT OF TERMS By checking this box you acknowledge and accept that you have read and agree to the terms of the attached Simplex “Document”( Retail Acknowledgement ). Additionally, the contents of this “Document” are referenced and incorporated into the Simplex Sales Contract.
ACCEPTABLE METHODS OF PAYMENT document*
- Acceptable Methods of Payment - ACCEPTED
ACKNOWLEDGEMENT OF TERMS By checking this box you acknowledge and accept that you have read and agree to the terms of the attached Simplex “Document”( Acceptable Methods of Payment ). Additionally, the contents of this “Document” are referenced and incorporated into the Simplex Sales Contract.
Upon acceptance of your application, a certificate of insurance will be required naming Simplex Industries Inc. as the Certificate Holder and additionally insured.

Click here to view a sample Certificate of Insurance.

If the certificate is not available to you now, you will be able to submit this on our Builder Resource Center page at a later date.
Certificate of Insurance
Accepted file types: pdf, jpg, png.

Save and Continue Later

By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "Submit" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Simplex Industries, Inc.. You are also confirming that you are the individual authorized to enter into this Agreement.

By Signing your name below, this electronic signature signifies that you have agreed, read and accepted the terms and conditions of the following documents: Delivery Confirmation, General Information and Policies, Simplex Industries Builder/Purchaser Responsibilities, Retail Acknowledgement, and Acceptable Methods of Payment
Name of Signator*
Signature*
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Save and Continue Later

Purchaser's Application

Step 1 of 6 - Builder Information

Welcome to the Simplex Industries, Inc. Purchaser's Application

Second Trade Reference Information

Adobe PDF Reader Needed