Credit Application and Contract
Trade Name (Legal name of corperation, or if proprietorship or partnership, give name(s) of owner(s):
Email Address:
Tax exempt # (if not exempt, leave blank)
Billing / Mailing Address:
Shipping / Physical Address
Telephone # Fax #
Purchasing Agent: Telephone:
Accounts Payable: Telephone:
TRADE REFERENCES:
Name: Contact Person:
Address:
Telephone: Fax:
BANK REFERENCE:
Business Account Bank:
Bank Account #:
Bank Contact Person:
Bank Address:
This application is made to induce the extension of credit to above customer.
Thirty (30) days after invoice date, the unpaid balance will accrue late charges of 1.5% per month (minimum of $5.00) until arrearage is paid. If it becomes necessary to place the account in the hands of an attorney for collection, customer will pay court costs, attorney's fees, and discovery expenses. Venue will be in Orange County, Florida. If the customer is a corporation, the undersigned individual agrees to be a co-debtor for payment of any and all liabilities by corporation, until notice in writing is given to this creditor. By submitting this form, you agree to the above.
Name: Title: