(Here, just beneath the words 'CREDIT APPLICATION AND AGREEMENT', identify name of company of whom credit is requested giving address, telephone and fax numbers.)
The above-named COMPANY in consideration of and for the purposes of APPLICANT'S agreements and representations herein contained this CREDIT APPLICATION AND AGREEMENT (Agreement) shall include any subsidiary, parent company, division, affiliated, sister or related companies and entities, predecessor or successor-in-interest of COMPANY.
APPLICANT, whose legal name is ______________________, and whose principal place of business is at _________________, ________________, __________ herein applies to COMPANY for credit. For all purposes of this Agreement, APPLICANT herein acknowledges and agrees that the term "APPLICANT" shall include and apply to any subsidiary, parent company, division, affiliated, sister or related companies and entities, predecessor or successor-in-interest of APPLICANT.
I. APPLICANT IS A:
(1) Corporation. Yes ( ) No ( ) (If APPLICANT is a corporation, please indicate:
(a) State/Year of incorporation: and APPLICANT should attach to this document a copy of the latest corporation annual report filed in the state in which APPLICANT maintains its principal place of business.)
(b) President __________________, whose home address is _________________, ___________
and whose home telephone number is _________________________
(c) Treasurer __________________, whose home address is _________________, ___________
and whose home telephone number is _________________________
(d) Person authorized by APPLICANT to make credit decisions and commitments with regard to this Agreement _____________________, whose position with APPLICANT is _________________, whose home address is _________________, _____________, _____
and whose home telephone number is _________________________
(e) Federal Tax Identification Number/Social Security Number ____________________
(f) APPLICANT's telephone number: _________________________
APPLICANT's fax number: _________________________
APPLICANT's e-mail address: _________________________
(2) Partnership: Yes ( ) No ( ) (If APPLICANT is a partnership, please indicate the names, home addresses and home telephone numbers of all general partners on a separate piece of paper and attach it to this document. Also fill in categories (d) through (f) above.)
(3) Sole Proprietorship: Yes ( ) No ( ) (If APPLICANT is a sole proprietorship, please indicate its principal's name and home address and home telephone number on line (b) above. Also fill in categories (d) through (f) above.)
(4) Other: Yes ( ) No ( ) (If APPLICANT is not a corporation, partnership or sole proprietorship, please describe your organization in the following space: _____________________. Please indicate the names and home addresses of all principals of APPLICANT on a separate piece of paper to be attached hereto. If APPLICANT is a realty trust, please attach to this document a copy of the declaration of trust filed with the appropriate registry of deeds. If APPLICANT is a limited liability company or limited liability partnership, please attach to this document whatever organizational document is on file with the Secretary of State's Office/Department of Corporations in the state in which APPLICANT is organized. Also fill in categories (d) through (f) above.)
(g) Names and addresses of any affiliated companies or entities to APPLICANT
Name: __________________________; Address: ________________________
Telephone number: ____________________; Fax number: ____________________
Relationship to APPLICANT: _____________________________________
Name: __________________________; Address: ________________________
Telephone number: ____________________; Fax number: ____________________
Relationship to APPLICANT: _____________________________________
Name: __________________________; Address: ________________________
Telephone number: ____________________; Fax number: ____________________
Relationship to APPLICANT: _____________________________________
II. CREDIT AMOUNT/PROJECT APPLIED FOR:
If this application is for a specific project, please identify the project by Owner:
_________________, whose address is ___________________; the name of the project or job: ______________________________, the address of which is ________________________; the general contractor's name: ________________________, and principal address: ___________________, __________________, ___________; if the project is bonded, attach a copy of any payment bonds which might pertain to the same, including bonds given by APPLICANT or by the general contractor. If an open account status is request, please identify desired amount of credit: ______________________.
III. TRADE REFERENCES:
Name: __________________________________________
Street Address:_________________________________________________________________
Telephone and fax numbers: Telephone: __________________ Fax:_________________
Contact person: ____________________ Amount of current credit line:__________________
__________________________________________________________________ ____________
Name: _____________________________________________
Street Address:_________________________________________________________________
Telephone and fax numbers: Telephone: __________________ Fax:_________________
Contact person: ____________________ Amount of current credit line:__________________
__________________________________________________________________ ____________
Name: __________________________________________
Street Address:_________________________________________________________________
Telephone and fax numbers: Telephone: __________________ Fax:_________________
Contact person: ____________________ Amount of current credit line:__________________
__________________________________________________________________ ____________
Name: __________________________________________
Street Address:_________________________________________________________________
Telephone and fax numbers: Telephone: __________________ Fax:_________________
Contact person: ____________________ Amount of current credit line:__________________
__________________________________________________________________ ____________
Name: __________________________________________
Street Address:_________________________________________________________________
Telephone and fax numbers: Telephone: __________________ Fax:_________________
Contact person: ____________________ Amount of current credit line:__________________
__________________________________________________________________ ____________
IV. BANK REFERENCE:
Name:__________________________________; Account Officer: _______________________
Street Address of branch APPLICANT deals with: __________________, ____________, ____
Checking Account Number: ___________________; Credit line amount:___________________
Amount of Credit line currently available: _______________________
Telephone number: _______________________; Fax number: ______________________
V. INFORMATION CONCERNING APPLICANT:
(a) Type of APPLICANT'S licenses held: _________________________________________; in what state(s): ____________________, _____________________, ___________________
(b) Does APPLICANT have a current bonding program? Yes ( ) No ( )
(If yes, please give the name of your bonding company ___________________________ and please provide the following information concerning your insurance agent):
Name: ____________________________________________________________
Address: _________________, ______________, ______; Tel. number:____________________ Fax number: _____________________; Contact person: ________________________
(c) Has APPLICANT, including any predecessor company or business organization or APPLICANT'S current president or treasurer, ever filed for personal/corporate bankruptcy or insolvency or made an assignment for benefit of creditors in any state? If the answer is "yes", please provide full particulars on a piece of paper, attaching the same to this document.
(d) Current financial statement (audit, compilation or review) attached? Yes ( ) No ( )
VI. TERMS AND CONDITIONS:
In consideration of COMPANY'S evaluation of this application for credit and in consideration of any extension of credit to APPLICANT by COMPANY, if any - either previously or subsequently given - APPLICANT herein agrees and acknowledges that the following terms and conditions apply to its credit relationship with COMPANY and to COMPANY'S evaluation of this credit application:
1. COMPANY'S receipt of this filled-out Agreement is for its consideration of APPLICANT'S request for credit. All decisions as to the extension of initial credit or the continuation of the granting of credit or the denial of credit are herein acknowledged by APPLICANT as being solely within the purview and sole discretion of COMPANY.
2. APPLICANT acknowledges that the statements herein contained within Agreement are true to his/her/its knowledge and further acknowledges that the representations herein made are material to COMPANY'S consideration of this Agreement and that COMPANY will rely on the truth of the statements made herein.
3. APPLICANT herein authorizes COMPANY and its representatives to make such inquiry and to gather such additional credit information from any source in COMPANY'S sole discretion and hereby authorizes all such sources to answer such inquiry with true, accurate, current and complete information concerning APPLICANT.
4. Payments are due to COMPANY within thirty days of each rendered invoice. The 'rendered' date of any invoice is the earlier of the actual date of the invoice or the date the invoice is transmitted by COMPANY to APPLICANT.
5. Any invoices which are overdue and delinquent (meaning unpaid within thirty days after rendering) shall earn simple interest until such invoice is paid in good funds at the highest rate allowed by the law of the state COMPANY is located in or of whatever state law may be applicable to the transaction underlying the invoice or at the rate of twenty per cent per annum, whichever rate is lower.
6. If COMPANY in its sole judgment turns this account over to a collection agency or attorney for collection, APPLICANT herein agrees that such reasonable collection and legal fees and expenses will be added to APPLICANT'S indebtedness, whether or not suit is actually ever brought.
7. No representative of COMPANY can vary the terms of this Agreement by any oral statement.
8. APPLICANT herein warrants that every request he/she/it makes of COMPANY for the provision of goods and services constitutes an express representation that APPLICANT both intends to pay for such goods and services within the terms of this Agreement and has the ability to do so.
9. APPLICANT herein agrees to provide COMPANY with information about any change in the ownership or management of APPLICANT or of any changes to APPLICANT or his/her/its business which may have an impact on APPLICANT'S ability to comply with the terms of this Agreement.
10. APPLICANT herein agrees that COMPANY may offset any credits or monies otherwise due to APPLICANT on any of APPLICANT'S (or any of his/her/its affiliated companies' or entities') other jobs or general account as to amounts due to COMPANY as to any particular invoice(s).
11. To the greatest extent allowed by any applicable law, this Agreement shall be considered as a contract for any project to which COMPANY actually supplies goods and services to or which project such goods and services are actually intended for but shipped to a different location for purposes of any applicable mechanic's lien statute.
12. APPLICANT herein acknowledges that if the amount of credit granted to APPLICANT by COMPANY changes at any time, whether by increase or decrease, this Agreement will continue to apply to the credit relationship between APPLICANT and COMPANY.
13. As to COMPANY and APPLICANT'S obligations thereto under this Agreement, to the greatest extent allowable under applicable law, APPLICANT and any personal and other guarantors listed below waive any rights to prior presentment of claims, of dower, curtesy or homestead.
14. APPLICANT herein acknowledges and agrees that if APPLICANT'S account becomes delinquent and remains so for thirty days, to the greatest extent allowable under applicable law, this Agreement may serve as a security agreement for all purposes recognized under and by the Uniform Commercial Code.
15. APPLICANT herein specifically agrees that if any provision of this Agreement is void or unenforceable by any applicable law, all remaining provisions of Agreement shall remain in full force and effect.
16. This Agreement subsumes and replaces any prior oral or written agreements, representations or statements made by and between APPLICANT and COMPANY and their respective representatives.
17. This Agreement applies to any extension of credit and/or provision of goods and services to APPLICANT by COMPANY, whether made prior to or subsequent to the execution of this Agreement.
18. COMPANY'S actual extension of credit subsequent to APPLICANT'S execution of this Agreement or COMPANY'S execution of any other document or letter acknowledging its agreement with or acceptance of this Agreement shall be deemed as COMPANY'S execution of this Agreement for the purposes of entering into this Agreement.
Signed and sealed as a sealed instrument in _______________, __________________, this ______________ day of _______________, 1999.
___________________________________
APPLICANT'S LEGAL NAME
By: _____________________________
Position with APPLICANT: _________________________
Then appeared before me _____________________, this _________ day of ______________, 1999 to me personally known, who after being duly sworn stated that the execution of this Agreement was his/her free act and deed and that he/she is authorized by APPLICANT to execute the same on its behalf.
______________________________________
NOTARY PUBLIC
My commission expires:
VII. PERSONAL AND OTHER GUARANTORS:
In consideration of COMPANY'S consideration of this credit request and in further consideration of any credit which COMPANY may hereinbefore or hereafter extend to APPLICANT, each and every one of the undersigned individuals and companies do hereby, jointly and severally, agree to and guarantee each and every one of the obligations and terms assumed herein this Agreement by APPLICANT, waiving any suretyship or prior presentment to APPLICANT defenses. Any undersigned personal or other guarantor may terminate this guaranty by sending written notice to COMPANY at its principal place of business by certified mail, return receipt requested, with such termination to take effect ten days after COMPANY'S actual receipt of such termination but only as to any future provision of goods and services to APPLICANT from that tenth day forward. Further, each and every one of the undersigned personal and other guarantors acknowledges that he/she/it has received a valuable benefit by COMPANY'S consideration of this Agreement and/or from any extension of credit to APPLICANT by COMPANY, whether previously or subsequently made. This guaranty is for an indefinite term and will continue in full force and effect until terminated by any of the undersigned in accordance with this paragraph.
Signed and sealed in _______________, __________________, this ______________ day of _______________, 1999.
___________________________________
(Type name of person signing here) Soc.Sec./Federal tax I.D.#: __________________________
Residential Address: _________________________________
Then appeared before me _________________, this _________ day of ______________, 1999
to me personally known, who after being duly sworn stated that the execution of this Agreement was his/her free act and deed.
______________________________________
NOTARY PUBLIC
My commission expires:
Signed and sealed in _______________, __________________, this ______________ day of _______________, 1999.
___________________________________
(Type name of person signing here)
Soc.Sec./Federal tax I.D.#: __________________________
Residential Address: _________________________________
Then appeared before me _________________, this _________ day of ______________, 1999
to me personally known, who after being duly sworn stated that the execution of this Agreement was his/her free act and deed.
______________________________________
NOTARY PUBLIC
My commission expires:
Signed and sealed in _______________, __________________, this ______________ day of _______________, 1999.
___________________________________
(Type name of person signing here) Soc.Sec./Federal tax I.D.#: __________________________
Residential Address: _________________________________
Then appeared before me _________________, this _________ day of ______________, 1999
to me personally known, who after being duly sworn stated that the execution of this Agreement was his/her free act and deed.
______________________________________
NOTARY PUBLIC
My commission expires: