| NEW
ACCOUNT APPLICATION |
| *
email: |
|
| DATE |
,
|
| SALES
REP NUMBER |
|
|
PAYMENT IS DUE 30
DAYS FROM INVOICE DATE, AFTER 30 DAYS AN ACCOUNT IS CONSIDERED
PAST DUE. OUR CREDIT POLICY WILL NOT ALLOW US TO CREATE ADDITIONAL
CHARGES ON PAST DUE ACCOUNTS.
|
| FIRM NAME |
|
| PHONE
# |
|
| FAX # |
|
| DBA (IF
DIFFERENT FROM ABOVE) |
|
| ADDRESS
1 |
|
| ADDRESS
2 |
|
| CITY |
|
| STATE |
|
| ZIP |
|
| TYPE OF
BUSINESS |
|
| HOW LONG
IN BUSINESS |
|
| PRINCIPAL
OWNER OR OFFICER |
|
| OWNERSHIP |
|
| ARE YOU
TAX EXEMPT |
|
| EXEMPT
NUMBER |
|
| ANTICIPATED
MONTHLY CHARGES (IMPORTANT IN DETERMINING CREDIT) |
|
| DO YOU
REQUIRE A PURCHASE ORDER NUMBER |
|
| DO YOU
PAY FROM |
|
| DO YOU
PAY YOU BILLS |
|
| LIST PAYABLE
CYCLE |
|
| DO YOU
HAVE SPECIAL BILLING INSTRUCTIONS |
|
| DO YOU
PAY BY CREDIT CARD |
|
| CREDIT
CARD NUMBER |
|
| EXP. DATE |
|
| SHIPPING
ADDRESS 1 |
|
| SHIPPING
ADDRESS 2 |
|
| SHIPPING
CITY |
|
| SHIPPING
STATE |
|
| SHIPPING
ZIP |
|
| PURCHASING
PERSON |
|
| PURCHASING
TELEPHONE |
|
| PURCHASING
FAX |
|
| PURCHASING
EMAIL |
|
| ACCOUNTS
PAYABLE PERSON |
|
| ACCOUNTS
PAYABLE TELEPHONE |
|
| ACCOUNTS
PAYABLE FAX |
|
| ACCOUNTS
PAYABLE EMAIL |
|
| TRADE
REFERENCES 1 |
|
| TRADE
REFERENCES 1 CONTACT |
|
| TRADE
REFERENCES 1 ADDRESS |
|
| TRADE
REFERENCES 1 PHONE # |
|
| TRADE
REFERENCES 1 FAX # |
|
| TRADE
REFERENCES 1 EMAIL |
|
| TRADE
REFERENCES 2 |
|
| TRADE
REFERENCES 2 CONTACT |
|
| TRADE
REFERENCES 2 ADDRESS |
|
| TRADE
REFERENCES 2 PHONE # |
|
| TRADE
REFERENCES 2 FAX # |
|
| TRADE
REFERENCES 2 EMAIL |
|
| TRADE
REFERENCES 3 |
|
| TRADE
REFERENCES 3 CONTACT |
|
| TRADE
REFERENCES 3 ADDRESS |
|
| TRADE
REFERENCES 3 PHONE # |
|
| TRADE
REFERENCES 3 FAX # |
|
| TRADE
REFERENCES 3 EMAIL |
|
| BANK NAME |
|
| ACCOUNT
NUMBER |
|
| BANK CONTACT |
|
| BANK TELEPHONE
NUMBER |
|
| INDIVIDUALS
AUTHORIZED TO PURCHASE |
|
| AUTHORIZED
PHONE # |
|
I HAVE AUTHORIZED THE EMPLOYEES
LISTED ABOVE TO CHARGE PURCHASES AT THE FITCH CO. AND WILL NOTIFY
FITCH CO. IN WRITING OF ANY CHANGES. I AGREE TO THE CREDIT TERMS
STATED ABOVE.
PERSONAL GUARANTEE
IN CONSIDERATION OF THE EXTENSION
OF CREDIT BY FITCH CO. THE ABOVE NAMED CUSTOMER, THE UNDERSIGNED
DO JOINTLY AND SEVERALLY GUARANTEE TO PAY AND BE RESPONSIBLE
FOR PAYMENT OF ALL SUMS, BALANCES AND ACCOUNTS DUE FITCH CO.
BY CUSTOMER INCLUDING COLLECTION CHARGES AND/OR ATTORNEY'S FEES.
THIS SHALL BE AN OPEN AND CONTINUEING GUARANTEE AND SHALL CONTINUE
IN FORCE, NOTWITHSTANDING ANY CHANGE IN THE FORM OF SUH INDEBTNESS,
OR RENEWALS OR EXTENSION GRANTED BY FITCH CO. WITH OBTAINING
ANY CONSENT THERETO, AND UNTIL EXPRESSLY REVOKED BY WRITTEN
NOTICE FROM THE UNDERSIGNED TO FITCH CO. ANY SUCH REVOCATION
SHALL NO IN ANY MANNER AFFECT THE UNDERSIGNED'S LIABILITY AS
TO ANY INDEBTEDNESS EXISTING PRIOR THERETO. THE UNDERSIGNED
THEREBY WAIVES NOTICE OF ACCEPTANCE OF THIS AGREEMENT, NOTICE
OF DEFAULT OR NONPAYMENT AND WAIVE ACTION REQUIRED BY ANY STATUTE,
AGAINST THE CUSTOMER. NO DELAY ON FITCH CO.'S PART IN EXCERCISING
THE RIGHT HEREUNDER, OR TAKING ANY ACTION TO COLLECT OR ENFORCE
PAYMENT OF ANY OBLIGATION HEREBY GUARANTEED. AS AGAINST EITHER
THE CUSTOMER, SHALL OPERATE AS A WAIVER OF ANY SUCH RIGHT OR
IN ANY MANNER PREJUDICE FITCH CO.'S RIGHTS AGAINST THE UNDERSIGNED.
THE UNDERSIGNED AGREE THAT IN THE EVENT OF ANY DEFAULT AT ANY
TIME BY CUSTOMER, FITCH CO. SHALL BE ENTITLED TO LOOK TO THE
UNDERSIGNED IMMEDIATELY FOR FULL PAYMENT WITH PRIOR DEMAND OR
NOTICE.
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|
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| *
Required field |