|
APPLICATION FOR CREDIT DATE:______________________________ |
|
FOR THE PURPOSE OF OBTAINING MERCHANDISE FOR YOU ON CREDIT, THE FOLLOWING STATEMENT MADE IN WRITING IS WARRANTED TO BE TRUE, INTENDING THAT YOU SHOULD RELY ON SAME AS CORRECT. APPLICANT HEREBY AUTHORIZES THE FIRM, OR ITS AGENTS, TO WHOM APPLICATION IS MADE TO INVESTIGATE THE REFERENCES LISTED BELOW TO ASCERTAIN THE UNDERSIGNED'S PERSONAL PARTNERSHIP OR CORPORATE CREDIT AND FINANCIAL RESPONSIBILITY. APPLICANT: _______________________________________ BY: ________________________________________ BUSINESS NAME: _______________________________________________________________________________ BUSINESS TYPE: ________________________________________________________________________________ MAILING ADDRESS: _____________________________________________________________________________ CITY: __________________________________________ STATE: _______________ ZIP CODE: ________________ PHYSICAL ADDRESS (IF DIFFERENT FROM ABOVE): ___________________________________________________ CITY: __________________________________________ STATE: _______________ ZIP CODE: ________________ PHONE NUMBER: (_____) ________-__________ FAX NUMBER: (_____) ________-__________ EMAIL ADDRESS: _________________________________ PLEASE MARK HOW YOU WOULD LIKE TO RECEIVE YOUR INVOICE: ( ) FAX ( ) EMAIL OR ( )MAIL OWNERSHIP STYLE: ( ) CORPORATION ( ) PARTNERSHIP ( ) PROPRIETORSHIP FULL NAME (LIST ALL OWNERS): _________________________________________________________________ HOME ADDRESS: ______________________________________________________________________________ CITY: _________________________________________ STATE: _______________ ZIP CODE: ________________ PHONE NUMBER: (_____) ________-__________ SOCIAL SECURITY # _______________________________ BUSINESS STARTED: _______________________ CURRENT OWNERS SINCE: ____________________________ OTHER BUSINESS INTEREST OF OWNERS: FIRM NAME: _____________________________________________ ADDRESS: ____________________________________________________________________________________ BUSINESS LICENSES HELD: STATE: __________ CLASS: ____________ LICENSE # ________________________ NAME INSURED UNDER: ________________________________________________________________________ WE PURCHASE FROM THE FOLLOWING ON ACCOUNT: SUPPLIERS MAILING ADDRESS FAX NUMBER
BANK REFERENCES: BANK NAME: ____________________________________________ BRANCH: ______________________________ ADDRESS: ______________________________________________________ CHECKING ( ) SAVINGS ( ) ACCOUNT #: CHECKING _______________________________ SAVINGS __________________________________ CREDIT LINE: $____________________ AGREEMENT I/WE AGREE TO PAY FOR ALL CHARGES TO OUR ACCOUNT UNDER THE FOLLOWING TERMS AND CONDITIONS: I/WE REPRESENT, AS THE APPLICANT HEREIN, THAT ALL THE DEBTS ARE CURRENTLY BEING PAID IN THE NORMAL COURSE OF BUSINESS, AS THEY BECOME DUE, AND NO INSOLVENCY EXISTS AS DEFINED IN THE BANKRUPTCY REFOR ACT OF 1980, AND THAT ALL ORDERS WILL CEASE SHOULD THIS CONDITION AS TO INSOLVENCY BECOME INCORRECT. IN THE EVENT OF DEFAULT OF ANY PAYMENT THAT MAY BECOME DUE, I/WE AGREE TO PAY INTEREST AT THE RATE OF 1-1/2% PER MONTH IN THE PRINCIPAL BALANCE OWING, FROM THE DATE OF SUCH DEFAULT. PURCHASES MUST BE PAID WITHIN 30 DAYS OF THE BILLING DATE. IN THE EVENT SUIT IS FILED TO ENFORCE PAYMENT OF ALL SUMS DUE UNDER THIS AGREEMENT, I/WE AGREE TO PAY RESONABLE COURT COSTS AND ATTORNEY FEES. IN THE EVENT SUIT IS FILED TO ENFORCE PAYMENT, IT IS AGREED THE VENUE WILL BE IN THE COUNTY OF SACRAMENTO, STATE OF CALIFORNIA. DATE: _________________ APPLICATE: ___________________________________________ SIGNATURE (MUST BE SIGNED TO PROCESS): ___________________________________ PERSONAL GUARANTEE FOR CORPORATE DEBT IN CONSIDERATION FOR CREDIT WHICH MAY BE GRANTED BY WESTERN PACIFIC DISTRIBUTORS, INC. TO THE ABOVE APPLICATE CORPORATION, I/WE THE UNDERSIGNED AGREE TO FURTHER AND WHOLLY GUARANTEE ANY PAYMENT BY ______________________________ OR ITS AGENTS. I/WE AGREE TO THE TERMS LISTED IN THE ABOVE AGREEMENT. THE PERSONAL GUARANTEE FOR CORPORATE DEBT, MY BE REVOKED BY THE UNDERSIGNED UPON 30 DAYS WRITTEN NOTICE TO WESTERN PACIFIC DISTRIBUTORS, INC. (CREDITOR) OF THE UNDERSIGNED'S INTENSION TO REVOKE SAID PERSONAL GUARANTEE. THE UNDERSIGNED SHALL REMAIN LIABLE FOR ANY CHARGES INCURRED WITH WESTERN PACIFIC DISTRIBUTORS, INC. (CREDITOR) PRIOR TO THE END OF THE SAID 30 DAY PERIOD. ALL CORPORATE OFFICERS MUST SIGN: GUARANTOR: ___________________________________ DATE: ___________________ GUARANTOR: ___________________________________ DATE: ___________________
|
|