Allied Supply Company - Credit Application Business Name * Phone * (###) ### #### Fax (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Accounts Payable Contact Name * Accounts Payable Phone * (###) ### #### Accounts Payable Email * Federal ID# * (If exempt, please indicate and fax exemption certificate.) Type of Business * Date Established * MM DD YYYY Credit Line Requested $ * Do you require Purchase Orders * Yes No Purchasing Contact Name * First Name Last Name Does State, County, or City require a License? * Yes No If Yes, License # Ownership Sole Proprietorship Partnership Corporation LLC PRINCIPAL: * First Name Last Name Title * SS#/Drivers License# * TRADE REFERENCES (1) * First Name Last Name Phone * (###) ### #### Fax (###) ### #### TRADE REFERENCES (2) * First Name Last Name Phone * (###) ### #### Fax (###) ### #### TRADE REFERENCES (3) * First Name Last Name Phone * (###) ### #### Fax (###) ### #### BANK REFERENCES: * Institution Name) Bank Phone * (###) ### #### Bank Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Bank Contact Name * First Name Last Name Account Number * Routing Number * No. Of Employees * Est. Annual Sales * Sales Area * Has the firm or any of its principals ever been Bankrupt? * Yes No If yes, explain Name of Business * Any misrepresentation 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 undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principals listed. In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed (Net 30) and agrees to pay a service charge per month of 1% per month (12% annual percentage 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 or 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. Your Name * Your Title * Personal Guarantee * Personal Guarantee In consideration for Allied Supply Co., Inc. extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Allied Supply Co., Inc. by the business identified below whether said sums are due under open account, contract or otherwise. It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Allied Supply Co., Inc. and the business. Allied Supply Co., Inc. shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Allied Supply Co., Inc.. The guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Allied Supply Co., Inc.. Said notice shall specify the date on which this guaranty is to be terminated, said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination. First Name Last Name Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone * (###) ### #### Date * MM DD YYYY SS# * Signature of person guaranteeing payment * (Type Name for Electronic Signature) Name of Business whose account is guaranteed * Thank you!
