CREDIT APPLICATION AND AGREEMENT FOR LOANS UP TO $350,000Credit Application and Agreement • November 25th, 2019
LOAN REQUEST up to $350,000 $ MATURITY DATE (Month & Year) PRIMARY APPLICANT CO-APPLICANT Full Legal Name (as shown on State Driver’s License) Full Legal Name (as shown on State Driver's License) Address Address City State Zip City State Zip County Primary Phone Number County Primary Phone Number Email Email Social Security Number Date of Birth Social Security Number Date of Birth Gross Farm (Schedule F) Non-Farm Income Annual Income $ $ Total Assets$ Total Liabilities$ Total Assets$ Total Liabilities$ Marital StatusMarried Unmarried Separated Marital StatusMarried Unmarried Separated Entity TypeCorporation Partnership Sole Proprietorship Sole Proprietorship w/DBA LLC Trust Joint Venture Company Name Company Address Company Tax I.D.# Company State of Formation Company City State Zip Primary Phone Number Total Assets$ Total Liabilities$
ContractCredit Application and Agreement • January 15th, 2013
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • October 11th, 2018
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • January 29th, 2016
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • September 2nd, 2020 • Louisiana
□ Corporation Limited Liability Company Partnership Sole Proprietorship Other _ _ MAILING ADDRESS CITY STATE ZIP SHIPPING ADDRESS CITY STATE ZIP PHONE EMAIL ADDRESS
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • October 20th, 2022
amongCredit Application and Agreement • August 6th, 2004 • Dollar Thrifty Automotive Group Inc • Services-auto rental & leasing (no drivers) • New York
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • December 29th, 2023
This Application is required by Webb Concrete and Building Materials, Inc., for the purposes of evaluating credit applications and for establishing terms upon which credit may be granted. Neither this Application nor any extension of credit hereunder creates any continuing obligation on the part of Webb Concrete and Building Materials, Inc., its owners, agents, or employees. The applicant understands that Webb Concrete and Building Materials, Inc. reserves the right to terminate any extension of credit at any time, with or without notice, for any reason, and to change the terms by which credit is extended at any time, with or without notice, for any reason.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • February 26th, 2021 • South Carolina
Applicant hereby applies for credit with Integral Rx, a department of J M Smith Corporation (“Wholesaler”). Applicant separately agrees to the terms of this agreement. Please fax the completed Credit Application to 864-586-7375 or email it to info@integral-rx.com.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • July 26th, 2013
CONTACT NAME FOR PAYMENTS TELEPHONE NUMBER FAX NUMBER EMAIL ADDRESS PROPRIETORSHIP PARTNERSHIP INCORPORATED TYPE OF BUSINESS/SIC NO. DATE BUSINESS STARTED PARENT CO. NAME AFFILIATED COMPANIES IF ANY ARE P/Os MANDATORY FOR ALL PURCHASES? YES: NO:
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • April 14th, 2020
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • May 14th, 2018 • Kentucky
The undersigned CUSTOMER is applying for credit with Mills Supply Co., Inc./Con-Quip (the "Company") and agrees to abide by the terms and conditions of the Company's standard contract. THE CUSTOMER CERTIFIES THE FOLLOWING CREDIT INFORMATION IS CORRECT, AND AUTHORIZES AND DIRECTS THE BANKS AND SUPPLIERS INDICATED BELOW TO VERIFY SAID INFORMATION AND GIVE ADDITIONAL REQUESTED INFORMATION TO MILLS SUPPLY CO./CON-QUIP, INC. UPON REQUEST AND RELEASES SAID PARTIES FROM ANY LIABILITY IN CONNECTION THEREWITH. THE CREDIT APPLICANT/CUSTOMER, THEIR LEGAL REPRESENTATIVES SUCCESSORS AND ASSIGNS HEREBY AGREE TO BE BOUND TO THE TERMS AND TO THE FULL PERFORMANCE OF THE COVENANTS ON THIS AND THE FOLLOWING PAGES OF THIS AGREEMENT. THE UNDERSIGNED FURTHER PERSONALLY GUARANTEE THE PERFORMANCE BY THE CUSTOMER, PURSUANT TO THE TERMS OF THE GUARANTY PROVISION AT THE END OF THIS CREDIT APPLICATION.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • February 18th, 2020
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • March 24th, 2014
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • November 11th, 2019 • Texas
. This Agreement is effective from the date noted hereinabove, until the Agreement is terminated in writing by either party.
MEMBER BUSINESS CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • November 25th, 2014
Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who obtains a loan. When you request a loan, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license, passport or other identifying documents.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • June 16th, 2011
BUSINESS CONTACT INFORMATION Company Name: Line of Credit Requested: $ Primary Business Address: City: State: ZIP Code: Phone: Fax: E-mail: How long at current address? Date Bus. Est: Website: Type of Business: Blakely Rep (salesman): Billing Address (if different): City: State: ZIP Code: Shipping Address (if different): City: State: ZIP Code: Sole Proprietorship: Partnership: Corporation: Other: Owner/Principal Name: Title: SS# Owner/Principal Name: Title: SS# Owner/Principal Name: Title: SS# Purchasing Contact: Phone: E-Mail: Accounts Payable Contact: Phone: E-Mail: Send Invoices Via: Mail / Fax / Email (circle one) PO # Required: Y / N Side mark Required: Y / N BANKING INFORMATION Bank name: Bank address: City: State: ZIP Code: Phone: Contact name: Checking Acct #: Loan Account #: BUSINESS/TRADE REFERENCES Company name: Acct #: Address: City: State: ZIP Code: Phone: Fax: E-mail: Company name: Acct #: Address: City: State: ZIP Code: Phone: Fax: E-mail: Company name: Acct #: Address:
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • February 10th, 2016 • California
I/WE (hereinafter “Customer” or “Applicant”) herewith make application to Plavan Commercial Fueling, Inc. DBA P-Fleet (hereinafter “P-Fleet”) for credit, or an increase reconfirmation of our existing account under this Credit Application and Agreement (hereinafter “Agreement”). The undersigned Applicant gives and grants P-Fleet, or its agent, permission to verify and re-verify all information stated herein at any time. Applicant hereby agrees that all credit granted and/or extended will be paid timely in accordance with P-Fleet’s normal terms. Applicant does affirm that all information is true and correct. PLEASE ANSWER ALL QUESTIONS. (If more space is needed, a continuation sheet may be attached.)
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • August 16th, 2023 • Oregon
APPLICANT INFORMATION LEGAL NAME OF BUSINESS OR APPLICANT’S NAME (Required) TRADE NAME FINANCE CONTACT NAME FEDERAL TAX ID OR SOCIAL SECURITY NUMBER (Required) CREDIT AMOUNT REQUESTED TYPE OF BUSINESS STRUCTURE (CHECK ONE): PARTNERSHIP CORPORATION SOLE PROPRIETOR_ COOPERATIVE LLC (Limited Liability Corporation) LLP (Limited Liability Partnership) OTHER HEADQUARTERS ADDRESS, CITY, STATE, ZIP BILLING ADDRESS, CITY, STATE, ZIP (IF DIFFERENT FROM ABOVE) SHIPPING ADDRESS, CITY, STATE, ZIP (IF DIFFERENT FROM ABOVE) TELEPHONE NUMBER EMAIL ADDRESS TAX STATUS (ATTACH COPY OF EXEMPTION CERTIFICATE OTHERWISE TAX WILL BE CHARGED: EXEMPT TAX LIABLE WEB ADDRESS
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • March 2nd, 2015
CREDIT AMOUNTS REQUESTED Pacific Customs Brokers Ltd. Pacific Customs Brokers Inc. PCB Highway Sufferance Warehouse Net 15 Days $ Net 15 Days $ Net 30 Days $ Net 30 Days $ BASIC INFORMATION Legal Company Name Doing Business As Year Established Business Address TYPE OF COMPANY General Partnership Sole Proprietorship Limited Liability Company Corporation Individual Limited Partnership Other City Province / State Postal / Zip Code Country Mailing Address (if different) Type of Business / Industry City Province / State Postal / Zip Code Country Telephone Number Fax Number Email Website Company Incorporation # IRS / SS # Canadian Business GST#/HST# US Customs Bond # BANK INFORMATION Bank Name Address City Province / State Postal / Zip Code Country Telephone Fax Contact Name Contact Email
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • November 5th, 2018
Purchase Order Required to Charge on Account? YES NO Job Name or Number Required? YES NO BUSINESS REFERENCES – Please include any other rental company where you have an open account. Bank Affiliation: Account No. Phone No. Firm / Name Account No. City/ State Phone No. Fax No. Firm / Name Account No. _City/ State Phone No. Fax No. Firm / Name Account No. City/ State Phone No. Fax No. INSURANCE REQUIREMENTS: (Accepted applicants must provide CRESCO with the following coverage)1. CERTIFICATE OF INSURANCE / GENERAL LIABILITY:• Liability limits not less than; 1 million per occurrence, 2 million aggregate• 30 days Notice of Cancellation• CRESCO to be named as Additional Insured2. AUTO LIABILITY (If renting trucks or trailers):• Any Auto/Non-Owned – 1 Million3. PROPERTY DAMAGE on Rented/Leased Equipment:• CRESCO named as Loss Payee for not less than $100,000 per item for standard rental fleet• CRESCO named as Loss Payee for not less than $500,000 per item for extended earthmoving fleet•
ContractCredit Application and Agreement • July 21st, 2011 • Florida
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • October 31st, 2016
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • August 5th, 2004
To induce the extension of an open credit account or COD terms, Applicant authorizes release of information from trades and banks listed above and the use by STS Operating, Inc. ("SunSource") of credit reporting firms to check Applicant's payment history, and agrees to the terms and conditions set forth below and on the reverse side hereof.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • October 10th, 2011
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • April 5th, 2012
ContractCredit Application and Agreement • December 31st, 2019
CREDIT APPLICATION AND AGREEMENT Please Note - If you are returning your own Internal Credit Reference form, complete Sections 1, 2 & 5 only. Thank you Section 1 Individual Corporation Sole Proprietor Partnership Other REGISTERED LEGAL CORPORATE NAME : Trade Style Name (if applicable): If company is a subsidiary, provide name of parent company: Invoice Address: City: Prov / State: Postal / Zip Code: INCORPORATION / REGISTRATION DATE : TYPE OF BUSINESS: Business Premises: Owned# of Employees: ANTICIPATED PURCHASING REQUISection 2NAME OF ALL OFFICERS, PARTNAME 1 2 3 Financial Contact: Accounts Payable Contact : A/P email address: Purchasing Contact : DUNS # : Section 3TRADE REFERENCES: (STEEL SUCompany 1 . 2 . 3 . Section 4BANK INFORMATION: Name:Address: Prov / State: Section 5Terms and Conditions: Terms of sale c writing by Metalex. Metalex reserves the account is placed with a third party for c will not be accepted for returns unless auThe above information is supplied for the
CREDIT APPLICATION AND AGREEMENT BURNCO TEXAS LLCCredit Application and Agreement • June 29th, 2016
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • June 11th, 2019
BANK: CITY: PHONE #: EMAIL: NAME OF ACCOUNT OFFICER: TRADE REFERENCES (EXCLUDE C.O.D.,) NAME: ADDRESS: PHONE #: EMAIL: ACCT #: NAME: ADDRESS: PHONE #: EMAIL: ACCT #: With the advancements in technology and the need to receive information faster, we are offering our customers new options to receive their invoices and statements. (Please write down e-mail or fax number if different from above.) Invoices: What would you like us to do with invoices that are not sent out with the feed?❑ E-mail them to me. ❑ Toss them because the information will be on my statement. Statements: How would you like to receive your monthly statements?❑ E-mail them to me. ❑ Mail them to me.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • April 16th, 2024
BUSINESS CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • March 12th, 2021
Section A – Applicant Information Legal Business Name Business Phone No. Fax No. DBA “Doing Business As” (if applicable) Contact Name & Email Address (if available) Business Street Address City State Zip Description of Business Yrs in Business State of Incorporation/Organization/Formation ! Proprietorship ! Corporation ! General Partnership ! Limited Partnership ! Limited Liability Company (LLC) Federal Tax ID No. Tax Exempt? (if so, provide certificate)! Yes ! No Section B – Personal Information: Officers, Managers, Members, Partners, Authorized Representatives and/or Guarantors Name % Ownership Title Social Security No. Home Address City State Zip Name % Ownership Title Social Security No. Home Address City State Zip Name % Ownership Title Social Security No. Home Address City State Zip Name % Ownership Title Social Security No. Home Address City State Zip Section C – Bank and Trade Reference Information Bank Name City State Zip Phone No. Fax No. Account No. Officer’s Name Trade Refe
CREDIT APPLICATION AND AGREEMENT FOR CREDIT SALESCredit Application and Agreement • May 3rd, 2017
To: City Lights, Inc.: For the purpose of procuring and establishing credit, from time to time, the undersigned Applicant furnishes the following information, including the attached Financial Statement. Applicant represents and warrants said information is true and correct and a true and complete statement of its financial condition.
CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • March 12th, 2020
A#: Date: Company/Account Name: Sales Rep: Address: City: State: Zip: Phone: Fax: Co Email: Personal Email: Type of business: Corporation Partnership Sole Proprietorship Federal ID: Years in business: Are you tax exempt? If yes, please forward tax exempt forms
CREDIT APPLICATION AND AGREEMENT Cust. CodeCredit Application and Agreement • March 27th, 2009
Principal Activities: Tax ID/SSN Contractor’s License No: Web Address: Form of Org: Proprietorship Partnership LLC Corporation State of Incorporation Date Established: Years Under Present Ownership / Management:
ContractCredit Application and Agreement • June 7th, 2017
