CREDIT APPLICATION
The undersigned, hereinafter referred to as the BUYER, who will be responsible for all payments, hereby requests ALDEN LEEDS, INC., hereinafter referred to as the SELLER, to extend credit to:
Sold to: Name________________________________Phone_________________________
Address____________________________________________________________
City_____________________________State_______________Zip______________
Ship to: Name________________________________Phone_________________________
Address____________________________________________________________
City_____________________________State_______________Zip______________
CIRCLE ONE ð Corporation Partnership Sole Proprietorship
TERMS
Any and all orders hereinafter placed by the above BUYER with the SELLER shall be subject to the following terms and conditions:
1) Terms are NET upon receipt of invoice unless otherwise specified.
2) If the BUYER is a corporation, the president or principal shareholder who has executed the agreement, personally guarantees payment of any and all indebtedness hereinafter incurred by said corporation pursuant to the terms of the agreement.
3) If the BUYER is a partnership or sole proprietorship, the partner or owner who has executed the agreement, personally guarantees the payment of any and all indebtedness hereinafter incurred by said partnership or sole proprietorship pursuant to the terms of the agreement.
4) BUYER agrees to pay reasonable attorney’s fees and disbursements if SELLER is compelled to place any indebtedness hereinafter incurred by the BUYER with an attorney for collection.
5) BUYER agrees to pay interest on indebtedness incurred which in past due at the rate of 1½ % per month, computed monthly or at time of payment, whichever occurs first.
Signature:___________________________________________Title___________________
Print Name:_________________________________________Date:___________________
PLEASE COMPLETE THE FOLLOWING:
Names of owners, partners, or officers (if corporation, list titles of all officers).
Name________________________________ D.O.B. __________________________
Address______________________________
_____________________________ S.S. # _ _ _ - _ _ - _ _ _ _
Phone_______________________________
Name________________________________ D.O.B. _____________________________
Address_______________________________
_______________________________ S.S. # _ _ _ - _ _ - _ _ _ _
Phone #_______________________________
Person to contact in the event of a question _______________________________________
BANK REFERENCE (NOTE: Most banks require your hand written authorization.)
Bank Name_____________________________________Phone_______________________
Address________________________________________Account#_____________________
City_________________________________State___________________Zip_____________
I GIVE AUTHORIZATION TO RELEASE TO ALDEN LEEDS, INC. INFORMATION ON MY ACCOUNT. THIS INFORMATION IS LIMITED TO: Date account opened, Average daily balance and Borrowing or Non-Borrowing account *.
TRADE REFERENCES: *sign here for bank authorizationà :_____________________
Name_______________________________ Name________________________________
Address_____________________________ Address______________________________
____________________________________ _____________________________________
Phone_______________________________ Phone________________________________
Fax_________________________________ Fax__________________________________
Name_______________________________ Name________________________________
Address_____________________________ Address______________________________
____________________________________ _____________________________________
Phone_______________________________ Phone________________________________
Fax_________________________________ Fax__________________________________
SALES TAX STATUS (circle one) ð Taxable Exempt
If sales tax exempt, sales tax exemption certificate must be attached.
PRINT NAME_______________________________________Date: ___________________
Please print the above on company letterhead.