FIRM NAME__________________________________________ PHONE__________________________ ADDRESS____________________________________________________________________________ CITY________________________________________ STATE_________________ ZIP_______________ TYPE OF BUSINESS_____________________________________ DATE ESTABLISHED_____________ (State type and nature of business) OURS IS A:________________ CORPORATION____________ PARTNERSHIP____________ INDIVIDUAL WE WERE INCORPORATED UNDER STATE LAWS OF_______________ FED. I.D.#_________________ OPERATES FROM__________ RESIDENCE___________ SHOP_____________ OFFICE FULL NAME(S) AND ADDRESS OF ALL OWNERS OR PRINCIPAL OFFICERS NAME/TITLE ADDRESS CITY, STATE, ZIP CODE _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ PERSON TO CONTACT REGARDING ACCOUNTS PAYABLE____________________________ PURCHASE ORDER NECESSARY:______ YES_______ NO NO. OF INVOICES REQUIRED___ SPECIAL INSTRUCTIONS:________________________________________________________ MAILING ADDRESS FOR INVOICES:________________________________________________ MAILING ADDRESS FOR STATEMENTS:____________________________________________ CURRENT NUMBER OF
EMPLOYEES __________
TAXABLE_______ YES________ NO INSURANCE CARRIER & ADDRESS________________________________________________ _____________________________________________________________________________ EXPECTED MONTHLY CREDIT REQUIREMENT FROM YOU TO BE $______________________ REFERENCES SUPPLIER/VENDOR CONTACT PHONE NO. ADDRESS, CITY, STATE, ZIP CODE 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ 4._____________________________________________________________________________ 5._____________________________________________________________________________ BANK CONTACT PHONE NO. ADDRESS, CITY, STATE, ZIP CODE 1._____________________________________________________________________________ 2._____________________________________________________________________________ TERMS AND CONDITIONS OF CREDIT FROM Summers Organization LLC (1) This application is submitted by the undersigned (herein referred to as "applicant") for the purpose of obtaining a credit account with Summers Organization LLC. All representations are accurate, complete and truthful to the best of the Applicant's knowledge and belief. (2) The Applicant hereby authorizes any individual, firm, or corporation given as a credit reference to disclose to Summers Organization LLC orally or in writing, any information which is pertinent to this application. (3) If the Applicant is a corporation, the undersigned affirmatively states that he or she is authorized to make application on behalf of said corporation and to obligate same for any credit extended thereto as a result of this application; and further that the corporation on whose behalf application is hereby made will continue to be bound and obligated for any credit advanced thereto until notice to the contrary is given in writing to Summers Organization LLC, 345 East Main Street Suit H, Jackson, OH 45640. (4) If Applicant presents a Financial Statement as a part of this application, it will be attached hereto and made a part hereof. Applicant agrees to submit Financial Statements when requested by Summers Organization LLC. Any Financial Statements submitted in connection with this application or as requested by Summers Organization LLC will be accurate, complete and truthful. (5) Credit extended by Summers Organization LLC to Applicant shall be due when billed to Applicant. Applicant agrees to pay the amount due within 30 days following the due date. If Applicant's account becomes 30 days past due, it will be subject to a FINANCE CHARGE OF 2% per month on the outstanding amount. This is an ANNUAL PERCENTAGE RATE OF 24%. It is expressly understood by Applicant that the existence of the FINANCIAL CHARGE does not affect Applicant's obligation to pay the account in full when due. Applicant's account will be delinquent when any part of the account is ____ days past due. (6) If necessary to bring suit to collect, suit would be filed in Jackson County. (7) Notice to Applicant-Do not sign this agreement until you have read it. You are entitled to a copy of the signed agreement. Signed____________________________________ Social Security Number_______________________ Date______________________________________
FOR VALUE RECEIVED,
and to induce Summers Organization LLC to extend credit Signed____________________________________ (Guarantor)________________________________ Date______________________________________ Home Address_______________________________ ___________________________________________ ___________________________________________ Home or Cell Phone #_________________________ Social Security #_____________________________ Drivers License #_____________________________ |