Commerical Credit Application

Date ___________

Name of firm or corporation ______________________________________________

Phone _________________________________________

Billing Address _______________________________________ For Past ___years

City ________________________ State ___________ Zip Code__________________

Shipping Address _______________________________________________________

D/B/A _____________________ Federal tax ID number _________________

Former Business Address (If Applicable) _____________________________________

Type of Business _________ Date Established _______ How long in business______

Does State, County or City require a license? Yes No

If Yes, License # ________________

Ownership: Sole Owner Partnership Corporation

Principal: _______________________________________________________
                           (Name)                      (Title)                    (Phone #)

Principal: _______________________________________________________
                           (Name)                      (Title)                    (Phone #)

Principal: _______________________________________________________
                           (Name)                      (Title)                    (Phone #)

Trade References: (Name of major products and services)

NAME                                                                           ADDRESS/PHONE

_________________________  _________________________________

_________________________  _________________________________

_________________________  _________________________________

Bank Reference:   Checking  Loan  Savings                                          

_________ __________________________ _____________ _______________
      (Name)                      (Address)                                 (Acct #)         (Contact)


_________ __________________________ _____________ _______________
       (Name)                      (Address)                                (Acct #)          (Contact)


No. of Employees ________ Est. Annual Sales $_______ Sales Area _________

Has the firm or any of its Principals ever been bankrupt? Yes No

If Yes, Explain:_____________________________________________________


Other Business Debts

Name                                      Address                                                       Balance Due

_____________ _____________________________________ _______________

_____________ _____________________________________ _______________

_____________ _____________________________________ _______________

Person to Contact About Invoices:

(Name)                           (Title)                           (Phone #)                          (Fax#)


The undersigned will/will not submit a financial statement. Any misrepresentation in this application will be considered evidence of a fraud, since this information is the basis for the granting of credit.

As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed.



Title:__________________________________ Date:________________________


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In consideration of credit being extended by ______________________________to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership. a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to ________________________ the faithful payment, when due, of all accounts of said applicant for the purchases made within five years next after the date of this application. The undersigned guarantor or guarantors, each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by __________________________, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Absent written permission by creditor, this personal guarantee may not be revoked.

(Name)                   (Title)                         (SS#)                           (Home Address)

Do not write below this line.

Date Line of Credit Approved: __________

Date Line of Credit Denied:     ___________

Comments: ________________________________________________________________

In consideration for credit being extended, I or we acknowledge and agree the following: (1) Payment is jointly, severally and unconditionally guaranteed within 30 days of date of delivery; (2) any charges unpaid after the above 30 days are to be increased by 11/2 % per month; (3) any charges still outstanding after 90 days from the date of delivery are subject to collection or arbitration expenses , attorney’s fees, and court costs will be borne by the purchaser; (4) title to all work shall remain with the creditor until all invoices and additional charges have been paid in full; (5) all claims , requests for adjustments, or notification of errors must be made within 30 days, or charges are considered accepted; (6) this agreement shall apply to all current and future charges unless revocation is received by registered mail; (7) credit privileges may be withdrawn at any time without invalidating the terms of this agreement.

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