Business Contact Information

Legal Name Of Applicant:
D.B.A (Trade Name):
Address:
City:
State:
Zip Code:
Country:
Email:
Phone:
Fax:
In Business Since:
Business Type: Sole Trader   Partnership   Limited Liability   Other 

Business Principals/Owners

Principals/Owner Name Title Home Address Phone

Business Information

Name:
Phone:
Email:
Name Of Bank:
Phone:
Account Number:
Address:
City:
State:
Zip Code:
Opening Credit Required:
High Credit Required:

Major Trade Suppliers

Supplier #1 Supplier #2 Supplier #3
Name
Address
City
State
Zip Code
Phone
Fax
Email

IN ORDER FOR YOU TO DECIDE UPON THE ISSUANCE OF CREDIT I/WE HEREBY AUTHORIZE OUR ACCOUNTANT AND BANK TO FINISH YOU WITH ALL NECESSARY INFORMATION. I/WE ALSO AUTHORIZE YOU TO CONDUCT ALL PERTINENT CREDIT INVESTIGATIONS CONCERNING THE BUYER, ITS OWNERS AND/OR PRINCIPALS AND TO EXCHANGE FINANCIAL & OTHER RELEVANT INFORMATION WITH YOUR SUPPLIERS, CREDIT AGENCIES AND ANY OTHER SOURCE DEEMED NECESSARY.

Credit Authorized By:
Credit Signature (Full Name):

Agreement

THE SIGNATURE BELOW ATTESTS THAT THE APPLICANT IS FINANCIALLY RESPONSIBLE AND SOLVENT & THAT THE INFORMATION AND STATEMENTS IN THIS CREDIT APPLICATION ARE TRUE AND ACCURATE.

 

THE APPLICANT UNDERSTANDS AND AGREES THAT THE FOLLOWING TERMS AND CONDITIONS SHALL APPLY TO ALL SALES TO BE MADE BY SUPPLIER TO APPLICANT.

 

 INTEREST   AMOUNTS NOT PAID BY DUE DATE SPECIFIED ON INVOICE ARE SUBJECT TO A MONTHLY INTEREST CHARGE OF 2% PER MONTH (24% PER ANNUM).
TRANSPORT THE APPLICANT ASSUMES ALL COSTS PERTAINING TO DELIVERY OF MERCHANDISE.
LOSS THE APPLICANT ASSUMES ALL RISK OF LOSS OF, OR DAMAGE TO, MERCHANDISE DURING TRANSPORT.
QUANTITY PART SHIPMENTS MAY BE MADE AND ORDERS SHALL BE CONSIDERED COMPLETE IF THE SUPPLIER IS UNABLE TO     DELIVER THE ENTIRE ORDER. IN SUCH EVENT THE APPLICANT WAIVES ITS RIGHT TO CLAIM A REDUCTION IN     PRICE OR CANCELLATION OF SALE.
LATE   DELIVERY THE APPLICANT SHALL NOT CANCEL AN ORDER DUE TO LATE DELIVERY UNLESS THE SUPPLIER HAS BEEN NOTIFIED IN WRITING PRIOR TO SHIPMENT
RETURNS NO MERCHANDISE MAY BE RETURNED WITHOUT PRIOR WRITTEN AUTHORIZATION OF THE SUPPLIER.
REFUSAL TO SHIP THE SUPPLIER MAY REFUSE TO SHIP ANY CONFIRMED ORDER IN WHOLE OR IN PART FOR ANY REASON IT DEEMS SUFFICIENT
OWNERSHIP OF PRODUCT UNLESS OTHERWISE AGREED TO IN WRITING, THE SUPPLIER RETAINS OWNERSHIP (SECURITY INTEREST) OF ALL MERCHANDISE SHIPPED UNTIL PAID FOR IN FULL BY THE APPLICANT.
LANGUAGE    IT IS THE EXPRESS WISH OF THE APPLICANT THAT THIS CREDIT APPLICATION AND AGREEMENT BE WRITTEN IN THE ENGLISH LANGUAGE, Es el deseo expreso del solicitante que esta aplicación y acuerdo de crédito sean escritos en el idioma Ingles.
Agreement Applicant:
Agreement Signature (Full Name):
  THE FOLLOWING SECTION SHOULD BE COMPLETED BY THE PROPRIETOR WHERE THE APPLICANT IS NOT AN INCORPORATED COMPANY

Consent

I AGREE THAT IN ORDER FOR YOU TO EVALUATE YOUR GRANTING OF CREDIT TERMS TO ME OR MY BUSINESS OPERATIONS AND THE CONTINUING MONITORING OF MY CREDIT STATUS WHICH INCLUDES ONGOING ELIGIBILITY FOR CREDIT, A PERSONAL INFORMATION FILE CONTAINING CREDIT AND NECESSARY RELATED PERSONAL INFORMATION MAY BE FORMED.

 

I MAY AT ANY TIME WITHDRAW CONSENT TO ALL OR ANY PART OF THE FOREGOING IN WHICH EVENT YOU MAY CEASE DOING BUSINESS WITH ME ON A CREDIT BASIC. EMPLOYEES OF YOURS, WHOSE JOB DESCRIPTION INVOLVES ASSESSMENT OF CREDIT WORTHINESS, SHALL HAVE ACCESS TO MY FILE.

 

MY SOCIAL INSURANCE NUMBER WILL BE USED ONLY TO IDENTIFY ME WITH CREDIT BUREAUS AND OTHERS FOR CREDIT HISTORY FILE EVALUATION.

 

I FURTHER CONSENT TO YOUR OBTAINING, DISCLOSING AND EXCHANGING ANY CREDIT AND NECESSARY PERSONAL INFORMATION ABOUT ME CONTAINED IN MYFILE AT ANY TIME, FORM, TO OR WITH ANY CREDIT BUREAU OR OTHER PARTY DOING BUSINESS WITH ME IN CONNECTION WITH ANY DEALINGS BETWEEN US PRESENTLY OR TO BE COMMENCED.

 

I UNDERSTAND THAT THE INFORMATION IN MY FILE SHALL BE USED ONLY FOR THE SPECIFIC PURPOSE MENTIONED AND IN THE MANNER HEREINABOVE DESCRIBED.

 

Consent Individual:
Consent In Business As:
Consent Signature (Full Name):