CREDIT APPLICATION
(PLEASE COMPLETE APPLICATION IN FULL)
BUSINESS NAME DATE
BUSINESS ADDRESS CITY STATE ZIP CODE
BILLING ADDRESS (If different from business address) CITY STATE ZIP CODE
BUSINESS PHONE # FAX # TYPE OF BUSINESS HOW LONG IN BUSINESS
OWNERS OR OFFICERS IF CORP.
NAME TITLE HOME ADDRESS HOME PHONE # SOC SEC #
1.
2.
3.
TRADE REFERENCES
COMPANY ADDRESS HOME PHONE # SOC SEC #
1.
2.
3.
BANK REFERENCES
BANK NAME ADDRESS PHONE #
ACCOUNT # CITY STATE ZIP CODE CONTACT
TERMS

NET 10 FOLLOWING INVOICES, A FINANCE CHARGE WILL BE COMPUTED AT A PERIODIC RATE OF 1.5% ON THE UNPAID PREVIOUS BALANCE ON THE LAST DAY OF EACH MONTH. THIS IS AN ANNUAL PERCENTAGE RATE OF 18%. THERE WILL BE A MINIMUM FINANCE CHARGE OF $1.00 PER MONTH ON UNPAID BALANCES. BUYER GRANTS TO SECURED PARTY SELLER A SECURITY INTEREST - SUBJECT TO THE TERMS AND CONDITIONS HEREOF.

IN THE EVENT BUYER DEFAULTS IN PAYMENT OF ANY INSTALLMENT, THE SECURED PARTY HAS THE OPTION OF DECLARING THE ENTIRE INDEBTNESS DUE AND PAYABLE. SELLER AT ITS OPTION MAY TAKE BACK THE MERCHANDISE OR AFFIRM THE SALE AND HOLD THE BUYER LIABLE FOR THE UNPAID BALANCE INCLUDING ANY ATTORNEY OR COLLECTION CHARGES PERMITTED BY LAW.

EXPENSES OF RETAKING, SELLING AND LEGAL EXPENSES INCLUDING SECURED PARTYS REASONABLE ATTORNEYS FEES ARE FOR THE ACCOUNT OF, AND SHALL BE PAID BY THE BUYER.

UNDER CERTAIN CONDITIONS, BUYER MAY REDEEM THE PROPERTY IF REPOSSESSED.

SIGNATURE BY SOLD OWNER, PARTNERSHIP OR CORP. OFFICERS ONLY:

 
SIGNATURE DATE
 
TITLE