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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
Josue Lopez
Josh Richart
Nadia Guzman
Erika Ward
Ted Sheldon
River McCollum
Drue McCollum
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
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Name on card:
Card #:
Exp. Date:
CVC:
Billing Address is the same as the company address:
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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.
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
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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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