Credit Application

Application For Credit

Name of Firm or Individual
Federal ID Number Purchase Order Required
Credit Card Payment
Doing Business As (DBA)
Type of Business
Year Established
Years at Present Location
Address
Buyer's Name
Purchase Order Required?
City
State
Zip/Postal Code:
Ship To:
Phone
Fax
Address
Email Address
Accounts Payable Contact
City
State
Zip
Tax Exempt?
Tax Exempt Number
Phone
Fax
 
THE FOLLOWING MUST BE COMPLETED BY OWNERS, PARTNERS, OR OFFICERS
 
Ownership: Corporation Incorporated in
last 12 months
Partnership Proprietor / Social Security No:
Name(s) of Principal(s) Title Home Address City State Zip
1.
2.
3.
 
AUTHORIZATION: To induce Volland Electric Equip. Corp. to extend a line of credit for purchases under credit sales terms as stated on invoices, we authorize you to contact the banks and trade references listed below. We also understand that this information will be held in strict confidence and will be used solely for the consideration of extension of credit.
Signature (sign after printing form in next step) Title Date

BANK REFERENCE:
Bank Name
Address
City
State
Zip
Phone
Fax
Contact Account #

TRADE REFERENCES: (Suppliers Only - 4 references are required to process your credit application)
Business Name City State Account # Phone # Fax #
1.
2.
3.
4.

CREDIT TERMS AND CONDITIONS:
This credit application is valid for a period not to exceed 2 years from approval date. Credit can be withdrawn at any time for violation of the stated credit terms. Upon failure of applicant to pay any indebtedness to Volland Electric when due, the entire balance may be declared in default and immediately due and payable upon demand. Applicant agrees to pay any and all attorney fees, court costs, collection agency fees, etc. incurred in the collection of said account.
 
PERSONAL UNCONDITIONAL GUARANTEE
In consideration for the extension of credit by Volland Electric Equipment Corp., the undersigned guarantor individually, jointly, severally and unconditionally guarantees the prompt payment of all sums for which applicant becomes indebted to Volland Electric Equipment Corp.
 
Agreed By:
Signature of Applicant/Guarantor (sign after printing form in next step)
Date
Applicant/Guarantor's Printed Name
Title
   
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