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Locations
Murphy's • Arlington, TX
Murphy's • Biloxi, MS
Murphy's • Slidell, LA
Murphy's • Elmwood, LA
Ray's • Hammond, IN
Ray's • Chicago, IL
Products
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
Postal Code
Phone
Email
Website
Have You Purchased From Us Before?
Yes
No
Please Select Your Preferred Murphy's Location?
Arlington, TX
Biloxi, MS
Slidell, LA
Elmwood, LA
Rays - Chicago
Rays - Hammond
How did you learn about shopping with us?
Returning Customer
Contacted by a Sales Rep
Digital Media (Facebook, Craigslist, etc.)
Billboard Advertisement
Personal Referral
Other
Salesperson
Alejandro Alvarado
Drue McCollum
Erika Ward
James Zych
Jessie Vega
Josue Lopez
Josh Richart
Joshua Lopez
Katie Davis
Nadia Guzman
Rachel Garcia
River McCollum
Rosa Martinez
Ted Sheldon
Another Sales Representative
Preferred Language
Preferred method for receiving future promotional information
Call
Text
Email
Credit Card Authorization
Do you want your card on file?
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No
Credit Card Type
Visa
Mastercard
American Express
Discover
Name on card:
Card #:
Exp. Date:
CVC:
Billing Address is the same as the company address:
Yes
No
Billing Address
Billing City
Billing State/Region
Billing Zip
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.
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Date
As a Preferred Buyer of materials from Murphy’s Roofing Supply, I hereby authorize Murphy’s Roofing Supply to retain my credit card information for use on current and future purchases. My signature authorizes Murphy’s Roofing Supply 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
I agree to the Delivery Agreement
*
Yes
No
I agree to the Loading/Unloading Agreement
*
Yes
No
I agree to the Dumpster Delivery Agreement
*
Yes
No
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LOCATIONS
MURPHY'S - ARLINGTON, TX
MURPHY'S - BILOXI, MS
MURPHY'S - SLIDELL, LA
MURPHY'S - ELMWOOD, LA
RAY'S - HAMMOND, IN
RAY'S - CHICAGO, IL
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