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CONFIDENTIAL
APPLICATION FOR CREDIT |
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| 4909 Charlemar Dr. Cincinnati, OH 45227/ Ph: 513/271-3375 Fax: (513) 272-0314 |
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| Our credit terms are available for convenience of payment only, not for the purpose of financing your business. In today's economic climate, businesses |
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| have more difficulty in the area of "cash flow" than in any other area. Our policy is to remain financially strong and viable in order to be of continued good |
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| service to you and to faciliate expansion of our facilities necessary to meet your growing needs. To expedite the processing of this application, you must |
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| complete all information and sign. |
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CREDIT LIMITED REQUESTED: |
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Company Name:___________________________ |
Phone: ( )___________________ Fax: ( )________________________ |
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| Billing:____________________________________City:___________________State:______Zip:_____________________ |
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| Shipping:__________________________________City:___________________State:______Zip:_____________________ |
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| COMPANY's SALES TAX STATUS: |
____ Exempt |
____ Non-Exempt |
Fed Tax ID # ___________ |
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*If exempt, please complete certificate on next page of application |
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| TYPE OF BUSINESS: |
____Sole Owner ____Partnership ____Corporation ____Other:______________ |
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| GROSS ANNUAL SALES: |
____ $0-$50,000 ____$51,000-$100,000 ____$101,000-$500,000 ____Over $500,000 |
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| DATE BUSINESS STARTED:_________________________ |
NUMBER OF EMPLOYEES:_________________________ |
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| OFFICERS/PROPRIETORS: |
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| Name:__________________________________Position:______________________Social Security:________________ |
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| Name:__________________________________Position:______________________Social Security:________________ |
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| If planning to pay with VISA/Mastercard CARD NUMBER:______________________________EXP. DATE:___________ |
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| Bank Name___________________________________ Branch Location___________________________________ |
| Bank Account #_______________________________ |
| Bank Reference_______________________________ |
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Supplier:__________________________________ Phone: ( )__________________ Fax: ( )________________________ |
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| Address:_________________________________ City:________________________ State:_______ Zip:_______________ |
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| Account Number:____________________________________ Contact: __________________________________________ |
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| Supplier:__________________________________ Phone: ( )__________________ Fax: ( )________________________ |
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| Address:_________________________________ City:________________________ State:_______ Zip:_______________ |
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| Account Number:____________________________________ Contact: __________________________________________ |
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| Supplier:__________________________________ Phone: ( )__________________ Fax: ( )________________________ |
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| Address:_________________________________ City:________________________ State:_______ Zip:_______________ |
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| Account Number:____________________________________ Contact: __________________________________________ |
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| In the event the above company defaults in the performance of any obligation to EarthShades., I personally will be |
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| responsible for and will immediately discharge said obligations. |
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| Signature: |
_______________________________________________ Please Print Name:_______________________________________ |
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| Residence Address:______________________________ City:________________________ State:_______ Zip:_________ |
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| Phone: ( ) ____________________ Social Security: ____________________ Driver's License #:____________________ |
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| THE APPLICANT AGREES TO THE TERMS & CONDITIONS OF THIS OPEN ACCOUNT AGREEMENT AS FOLLOWS: |
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1. Payment in full is due within 30 days of the receipt of the EarthShades. invoice. |
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2. All legal fees, court costs and collection fees to be paid for by the applicant. In cas of defaul on the terms of this agreement. |
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3. Interest will be paid to EarthShades. By the applicant, at the rate of 2% per month on all money due over 30 days. |
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4. The applicant hereby gives permission to disclose its experience with the references above to EarthShades. |
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This information is to be used in consideration of granting an open account to the applicant. |
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5. A copy of this agreement is also as binding as the original. |
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| Authorized Signature: |
_____________________________________________Title:_______________________Date:___________ |
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| FOR OFFICE USE ONLY: Approved by: _______________________ Date:___________ Open Account Limit:__________________ |
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| Account Number:______________________________ Net Days:_____________________ Salesperson:_______________________ |
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