CREDIT APPLICATION Click here to return to the home page.   Company Name: DBA (If different): Contact Person: Federal tax ID or Social Security number: Street Address: City: State: Zip Code: Phone: Fax: Pager: Mobile: Type of Business: Date business established: Amount of credit requested: CORPORATIONS (only) Name: Title: Address: Name of resident agent: Address of resident agent: State of incorporation: Choose One Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Louisianna Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   PARTNERSHIP (only) Name: Address:     SOLE PROPRIETORSHIP (only) Are you sales tax exempt?   Yes: No: Have you had credit with us before?   Yes: No: If yes, under what name? Authorized purchasers (list all): Purchase order required?   Yes: No:   TRADE REFERENCES (all) Reference #1 Name: Address: Phone: Reference #2 Name: Address: Phone: Reference #3 Name: Address: Phone: Bank References Account #: Phone: Contact Person: Name of bank: Address: I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself. PLEASE CHECK: I have read the terms and conditions stated below and agree to all of these terms and conditions. Authorized signature (Please enter name): Title: Date: GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE Bills are sent on the first day of each month. You may take the 2% discount as indicated on the bill if you pay the invoice be the 10th of the month. All bills become payable in full on the 11th day of the month and if not paid by the end of the month are considered past due. A service charge of 2% per month will be added to all amounts billed if not paid by the end of the month. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. Customer is responsible for all and any reasonable cost associated with collecting on accounts. PERSONAL GUARANTEE: If the credit customer is a corporation, then by signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.