CREDIT APPLICATION PLEASE COMPLETE FRONT AND BACK SIDES FOR OUR CONSIDERATION OF YOUR APPLICATION. TYPE OR PRINT EXCEPT WHERE SIGNATURES ARE REQUIRED. DATE:________________________________________ BUSINESS NAME:________________________________________________________________ STREET ADDRESS:_______________________________________________________________ CITY:_____________________________ STATE:____________________ ZIP:_________________ BILLING ADDRESS(if different from above):______________________________________ SHIPPING ADDRESS(if different from above):_____________________________________ BUSINESS TELEPHONE:_________________ FAX______________________ D & B NUMBER_______________ ACCOUNTS PAYABLE CONTACT-NAME____________________________TELEPHONE_____________ ESTABLISHED IN THE YEAR ________AS A: CORPORATION_____________ PARTNERSHIP___________ PROPRIETORSHIP_____________ LIMITED PARTNERSHIP__________ IF INCORPORATED, CITY AND STATE IN WHICH INCORPORATED:_________________________ NAME & ADDRESS OF PARENT COMPANY, IF SUBSIDIARY:_______________________________ _______________________________________________________________________________ OWNERS OR CORPORATE OFFICERS: NAME:________________________________ TITLE:_____________________________ HOME ADDRESS:_______________________ TELEPHONE:_________________________ NAME:________________________________ TITLE:_____________________________ HOME ADDRESS:______________________ TELEPHONE:_________________________ BANK REFERENCE: BANK:________________________________ TELEPHONE:_________________________ ADDRESS:__________________________ CITY________________ ST_________ ZIP_________ OFFICER IN CHARGE OF YOUR ACCOUNT:_____________________________________________ CHECKING ACCOUNT
#_____________________________________________________________ TRADE REFERENCE: SUPPLIER:___________________________ TELEPHONE:______________ FAX:_______________ ADDRESS:___________________________ CITY_____________________ ST_________ZIP_________ SUPPLIER:___________________________ TELEPHONE:______________ FAX:_______________ ADDRESS:___________________________ CITY_____________________ ST_________ZIP_________ SUPPLIER:___________________________ TELEPHONE_______________ FAX:_______________ ADDRESS:___________________________ CITY_____________________ ST_________ZIP_________ I/WE HEREBY AUTHORIZE DOYLE’S SUPPLY TO REVIEW INFORMATION CONTAINED IN THIS APPLICATION AND AUTHORIZE OUR BANK AND TRADE REFERENCES TO RELEASE ANY REQUESTED INFORMATION FOR THE PURPOSES OF GRANTING CREDIT TO DOYLE’S SUPPLY UPON THEIR REQUEST. FIRM NAME_____________________________________________________________________ ________________________________________________ DATE:_______________________ (OWNER/PRINCIPAL SIGNATURE) ________________________________________________ DATE:_______________________ (OWNER/PRINCIPAL SIGNATURE) PERSONAL GUARANTEE 1. IN CONSIDERATION OF DOYLE’S SUPPLY INC. EXTENDING CREDIT TO THE ABOVE APPLICANT,FOR ANY MATERIALS AND/OR SERVICES AFTER THIS DATE AT THE REQUEST OF APPLICANT OR ITS’ AGENTS, THE UNDERSIGNED HEREBY PERSONALLY GUARANTEES UNCONDITIONALLY AND IRREVOCABLY THE PROMPT PAYMENT OF ANY SUMS NOW OR HEREAFTER OWED TO DOYLE’S SUPPLY INC. FOR GOODS SOLD, SERVICES RENDERED OR OTHER RELATED WORK PERFORMED AT THE REQUEST OF THE APPLICANT OR ITS’ AGENTS, WHETHER SAID SUMS ARE OR WILL BE DUE DOYLE’S SUPPLY INC. UNDER OPEN ACCOUNT, CONTRACT OR OTHERWISE. 2. THE UNDERSIGNED SHALL PAY TO DOYLE’S SUPPLY INC. FORTHWITH WHEN DUE, OR UPON DEMAND THEREAFTER, WITH INTEREST AT THE ANNUAL PERCENTAGE RATE OF 18% AND WITHOUT DEDUCTION FOR ANY CLAIM OF SET-OFF OR COUNTERCLAIM OF APPLICANT, THE FULL AMOUNT OF ALL OBLIGATIONS OR INDEBTEDNESS DUE TO DOYLE’S SUPPLY INC. FROM THE APPLICANT, TOGETHER WITH ALL EXPENSE OF COLLECTION AND REASONABLE ATTORNEYS’ FEES INCURRED BY DOYLE’S SUPPLY INC. BY REASON OF DEFAULT OF THE APPLICANT. 3. THE OBLIGATION OF THE UNDERSIGNED IS A PRIMARY AND UNCONDITIONAL OBLIGATION AND COVERS ALL EXISTING AND FUTURE INDEBTEDNESS OF THE APPLICANT TO DOYLE’S SUPPLY INC. THIS OBLIGATION SHALL BE ENFORCEABLE BOTH BEFORE AND AFTER PROCEEDING AGAINST THE APPLICANT OR AGAINST ANY SECURITY HELD BY DOYLE’S SUPPLY INC. AND SHALL BE EFFECTIVE REGARDLESS OF THE SOLVENCY OR INSOLVENCY OF THE APPLICANT AT ANY TIME, OR BY THE SUBSEQUENT INCORPORATION, REORGANIZATION, MERGER, OR CONSOLIDATION OF THE APPLICANT AT ANY TIME, OR ANY OTHER CHANGE IN COMPOSITION, NATURE, PERSONNEL OR LOCATION OF THE APPLICANT. GUARANTOR PRINTED NAME________________________________________________DATE_______________ GUARANTOR SIGNATURE__________________________________________TITLE________________________ HOME ADDRESS___________________________________________________________________________________ HOME TELEPHONE__________________________________________________________________________________ FAX or Mail this application back to Doyle's Supply, Inc |
