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CREDIT APPLICATION
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
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
OWNERSHIP
Sole Proprietorship
Sole Proprietorship
Partnership
Corporation
LLC
TRADE REFERENCES
BANK REFERENCES
Has the firm or any of its principals ever been bankrupt?
Yes
No
Any misrepresentatin in this application will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grant credit, the underisgned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principals listed.
In condideration for the extension of credit, said business promises to pay for all purchased within the terms agreed (Net 30 days) and agrees to pay a service charge of 1-1/2& per month (18% annual percentrage rate) on all past due balances. In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether of not litigation has commenced, and all costs of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.
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