Product Information

Customer Credit Application Form
 

  Company Name& Address

    Application Date:  
*Legal Business Name  

*Date Established

  Click Here to Pick up the date *Phone Number  
DBA          
*Billing Address
*City   *State   *Zip  
  Names of Principals of Firm        
*President   *CFO/Treasurer   *Email Address  
*Vice-President   *Controller      

         Corporation                        General Partnership                 Subsidiary Of: 

         Sole Proprietorship              Limited Partnership                 Division Of:     

Type of Business   Number Of Employees   Accounts Payable Contact  
Parent Company   Name/Title of Person Executing Guaranty on Behalf Of Parent Co.  
Address          
City   State

 

  Zip
  Credit Information        
Credit Line Desired Per Month Based on Projected Volume

 

Sales Representative

 

Do You Use Purchase Orders?

    Yes No

Buyer's Phone/FAX

 

Is Merchandise for Resale?

    Yes No

Buyer Name

 

  Authorization        
 

 FINANCIAL STATEMENTS:  Customer's most recent financial statements are required to be delivered with this credit application and

 shall be kept confidential.

     
  By Clicking "I Accept" below, I, (*Full Name),  (*Title),  dated* hereby certify that all of the information on this Credit Application is correct and agree to the following terms and conditions:
             
 

TERMS: Net 30 days.  This agreement supercedes all contrary or inconsistent provisions in customer's current or future purchase

order(s), or any other business form, and no modification of this agreement shall be binding unless executed in writing by a duly

authorized representative of each party to this agreement.  If the account(s) created by this agreement is forwarded to an attorney

or collection agency, customer agrees to pay all costs incident thereto, including reasonable attorney's fees.  Should the account(s)

created by this agreement become delinquent, Company shall have the right to refuse shipment of products to customer. 

This is the entire agreement. This agreement shall be governed by and construed in accordance with the laws of the State of California, excluding its body of law controlling conflicts of law. Venue for any action hereunder shall be in Santa Clara County, California.