Credit Application

Business Information
"Bill to" Legal Name:		D.B.A:
Fed. Empl. Id:		Type of Business:
Contact Person:		Tax ID:
Accounts Payable Contact:		E-mail:
Years in Business:		Annual Sales:
Address
Street:		PO Box:
State:		Phone:
Fax:		City:
Conditions of Sales
Our payment terms net 30. An account is placed on a "cash only basis" if check is returned from the bank, for whatever reason, more than once. Invoices not paid within terms are subject to a service charge from the date of invoice at the greater of 1 ½% per month (18% annually) or at the maximum rate allowed by the law. By submitting this application I authorize our banks, creditors and credit reporting agencies to release information to you. We further agree to abide by the terms stated in your invoices on price lists and agree in the event of default, to pay reasonable costs of collection and/or attorney fees and court costs for trial, post judgment and appellate proceedings.
	We, the applicant customer authorize my banks, creditors and credit reporting agencies to release information to you. We further agree to abide by the terms stated in your invoices, in your price lists and in your terms and conditions sheet, and agree in the event of default, to pay reasonable costs of collection and/or attorney fees and court costs for trial, post judgement and appellate proceedings. We hereby certifiy that all tangible personal property hereafter purchased by us is for purpose of resale, and assume liability for payment of Retailer`s Occupation Tax, Service Occupation Tax or Use Tax with respect to receipts from the resale of this property to users or consumers. This certificate shall be considered a part of each order which we shall give, unless such order otherwise specifies. We understand and accept that payment terms are net 30, an account is placed on a “cash only basis” if check is returned from the bank, for whatever reason, more than once and invoices not paid within terms are subject to a service charge from the date of invoice at the greater of 1 ½% per month (18% annually) or at the maximum rate allowed by the law.
PURCHASING FOR RESALE, PLEASE INDICATE THE FOLLOWING:
The undersigned hereby certifies that all tangible personal property hereafter purchased by him is for purpose of resale, and assumes liability for payment of Retailer's Occupation Tax, Service Occupation Tax or Use Tax with respect to receipts from the resale of this property to users or consumers. This certificate shall be considered a part of each order which we shall give, unless such order otherwise specifies.
(Authorized Agent):		Title:
Purchaser Resale Tax:
Bank Reference
Bank Name:		Address:
City:		State:
Zip:		Phone:
Fax;		Checking Account #:
Savings Account #:
Trade References
Name Street City State Zip Phone
Pick one	Corporation	Partnership	Proprietorship
Officer/Partner 1:		Title:
Officer/Partner 2:		Title:
Propietor:
Ptr1/Prop. Home Address:       Street: City: State: Zip: Phone: SS#: Ptr1/Prop. Home Address:       Street: City: State: Zip: Phone: SS#: Corporation's registered address:       Street: City: State: THE INFORMATION PROVIDED TO US WILL BE KEPT STRICTLY CONFIDENTIAL, YOUR ORDER CAN NOT BE PROCESSED WITHOUT FULLY EXECUTED APPLICATION   Credit Application & Agreement Credit Application & Agreement.pdf Credit Application & Agreement.doc