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Credit Application

Business Information

Company
Registered Company Address
City
State
Zip
Phone Number
Fax Number
E-Mail Address
Year Established
Type of Company
Tax Resale ID

Business Contact Information

Billing Address
City
State
Zip
Accounts Payable Contact Name
Accounts Payable Phone Number
Accounts Payable Fax
Accounts Payable E-Mail Address

Names And Titles Of Officers

Name and Title
of Owners or Officers
(enter one per line)

Agreement

Credit will be extended based on the business’ commercial credit score.

All accounts are due and payable not more than 30 days from their respective invoice dates unless otherwise negotiated. The seller reserves the right to apply an interest rate of 1.5% per month (18% annually) to any unpaid amounts from and after the 30th day following their respective invoice dates. Should it be necessary to engage others to collect past due moneys from the undersigned or the company, the seller shall be entitled to all costs, including collections fees, attorney’s fees, court costs, and any other reasonable expenses, both at trial and upon appeal.

Initials Of Corporate Officer *
Title
Date

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