3
APPLICATION FOR CREDIT Administrative Offices 7115 W Marginal Way SW Seattle, WA 98106 Phone: 206-762-5920 Fax: 206-767-0965 “The Service People!” 1 9 4 9 Trade References (Must include complete address with zip code, area code and phone number) Company Acct # Address Fax STREET CITY STATE ZIP Company Acct # Address Fax STREET CITY STATE ZIP Company Acct # Address Fax STREET CITY STATE ZIP Company Acct # Address Fax STREET CITY STATE ZIP Company Acct # Address Fax STREET CITY STATE ZIP Accounts Payable Contact Name of Bank Branch Checking Acct. # Name Social Security # PLEASE PRINT Home Address Home Phone STREET CITY STATE ZIP Name Social Security # Home Address Home Phone STREET CITY STATE ZIP Name Social Security # Home Address Home Phone STREET CITY STATE ZIP ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Phone Phone Phone Phone Phone ( ) IF YOU HAVE NO PRINCIPAL CREDIT SOURCES OF SUPPLY, OR IF YOUR FIRM HAS BEEN IN BUSINESS LESS THAN 6 MONTHS, PLEASE FILL OUT THE LAST PAGE OF THIS APPLICATION. Billing Requirements Purchase Order Required? Job Name/Number Required? List of Authorized Persons to Sign on This Account: (Any changes to this list MUST be submitted in WRITING) Yes No Yes No Company Name Credit Limit Requested Mailing Address Phone STREET CITY STATE ZIP Business Address STREET CITY STATE ZIP E-mail Address UBI Cell # Contractors Bond # Bond Company Type of Business- (circle one) Corp / Partnership / Individual / LLC Nature of Business Name of Parent Company (If Applicable) Address Phone STREET CITY STATE ZIP ( ) ( ) ( ) Phone Fax # ( ) ( ) must be physical address (Your “Legal” Name as it appears on your business/contractor’s license, then your d/b/a/ Name) Years in Business Branch Sponsor Email Address Revised Date: 05/24/2017 Page 1 of 3

Administrative O˜ces 1949 APPLICATION FOR CREDIT · Name of Bank Branch Checking Acct. # Home Name Social Security # PLEASE PRINT Address Home Phone ... an o˚cer or owner of said

  • Upload
    phamque

  • View
    218

  • Download
    5

Embed Size (px)

Citation preview

APPLICATION FOR CREDITAdministrative O�ces

7115 W Marginal Way SWSeattle, WA 98106

Phone: 206-762-5920Fax: 206-767-0965“The Service People!”

1949

Trade References(Must include complete address with zip code, area code and phone number)

Company Acct #

Address Fax STREET CITY STATE ZIP Company Acct #

Address Fax STREET CITY STATE ZIP

Company Acct #

Address Fax STREET CITY STATE ZIP

Company Acct #

Address Fax STREET CITY STATE ZIP

Company Acct #

Address Fax STREET CITY STATE ZIP

Accounts Payable Contact

Name of Bank Branch Checking Acct. #

Name Social Security # PLEASE PRINT

Home Address Home Phone STREET CITY STATE ZIP

Name Social Security # Home Address Home Phone STREET CITY STATE ZIP

Name Social Security # Home Address Home Phone STREET CITY STATE ZIP

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

Phone

Phone

Phone

Phone

Phone

( )

IF YOU HAVE NO PRINCIPAL CREDIT SOURCES OF SUPPLY, OR IF YOUR FIRM HAS BEEN IN BUSINESS LESS THAN 6 MONTHS, PLEASE FILL OUT THE LAST PAGE OF THIS APPLICATION.

Billing RequirementsPurchase Order Required? Job Name/Number Required?List of Authorized Persons to Sign on This Account: (Any changes to this list MUST be submitted in WRITING)

Yes No Yes No

Company Name Credit Limit Requested

Mailing Address Phone STREET CITY STATE ZIP

Business Address STREET CITY STATE ZIP

E-mail Address

UBI Cell #

Contractors Bond # Bond Company

Type of Business- (circle one) Corp / Partnership / Individual / LLC Nature of Business

Name of Parent Company (If Applicable)

Address PhoneSTREET CITY STATE ZIP

( )

( )

( )Phone

Fax # ( )

( )

must be physical address

(Your “Legal” Name as it appears on your business/contractor’s license, then your d/b/a/ Name)

Years in Business

Branch Sponsor

Email Address

Revised Date: 05/24/2017 Page 1 of 3

SALES AGREEMENTAdministrative O�ces

7115 W Marginal Way SWSeattle, WA 98106

Phone: 206-762-5920Fax: 206-762-5928“The Service People!”

1949

Revised Date: 05/24/2017

1) I/We make application to the Seller for credit or to obtain further credit with the Seller. I/We certify that the information supplied is true and correct to the best of my/our knowledge and further agree that a facsimile shall be as binding as an original signature.2) I/We promise to pay my/our account in full on or before the due date as de�ned on each invoice; verbal quotes on price & terms are not valid. Further, I/We agree to pay any and all late charges assessed at the rate of 18% per annum on past-due balances.3) I/We agree to be liable for all costs and expenses, including, but not limited to attorneys’ fees, legal expenses, & actual collection agency fees, incurred by the Seller in collecting amounts owed by Applicant, in enforcing any term of the sales agreement, in responding to defenses, a�rmative defenses, arbitration, and/or counterclaims raised by Applicant.4) If any term of this agreement is invalid, the invalid term shall be considered deleted from this agreement and shall not invalidate any other term(s) of this agreement.5) Venue and jurisdiction of any suit or legal action may be had in Seattle, King County, Washington at the sole option of the Seller.6) Applicant agrees to notify Paci�c Plumbing Supply Company LLC in writing, via certi�ed mail to 7115 W Marginal Way SW, Seattle WA 98106-1911, thirty (30) days prior to any change in the ownership, name or business structure of Customer, and further agrees to be jointly and severally liable for all purchases by the new business structure and/or owners should said noti�cation not be given.7) I/We acknowledge that the seller makes no warranty or guarantee expressed or implied beyond those state by the manufacturer. THE SELLER DOES NOT WARRANT THE FITNESS OR MERCHANTABILITY OF ANY GOODS.8) Applicant is solvent at this time and agrees to notify the seller if Applicant’s �nancial position changes or applicant is unable to meet its obligations.9) The Seller may terminate any credit terms and/or credit amount at any time within its sole discretion.10) This credit application and any rights arising under it may be assigned to another party by the seller at any time without Applicant’s consent. Applicant may not assign its obligations to the seller without prior written consent which may be withheld for any reason.11) In the event this application is made by individuals or a partnership or is personally guaranteed by individuals, the applicant and any guarantors acknowledge and agree that any credit to be extended by the Seller to the applicant will be business or trade debt, and shall not be for personal or family use.12) ORAL AGREEMENTS OR ORAL COMMITMENTS TO EXTEND CREDIT, OR TO FORBEAR FROM ENFORCING REPAYMENT OF A DEBT ARE NOT ENFORCEABLE UNDER WASHINGTON LAW, RCW 19.363110. THE SELLER WILL NOT BE BOUND BY ANY ORAL STATEMENTS.

MY/OUR SIGNATURE SERVES AS WRITTEN CONSENT FOR THE SELLER TO ACCESS PERSONAL AND BUSINESS CREDIT INFORMATION FOR THE PURPOSE OF DETERMINING MY/OUR CREDIT STANDING IN CONJUNCTION WITH OPENING A BUSINESS CREDIT ACCOUNT FOR WHICH I AM SOLELY LIABLE OR HAVE PERSONALLY GUARANTEED.

1) The undersigned, an o�cer or owner of said business for which application for credit is being made, and in consideration of the extension of said credit availability by the Seller does hereby absolutely and unconditionally guarantee, on a continuing basis, the performance of all obligations of the person(s) and/or entity(ies) that signed the above sales agreement and any and all obligations owed the Seller including but not limited to the prompt payment of all present and future indebtedness.2) This guarantee is irrevocable and is binding on Guarantor and Guarantor’s heirs, successors and assigns so long as any indebtedness remains unpaid or obligation unful�lled. The guarantee shall continue in e�ect until the undersigned has noti�ed the Seller in writing of its cancellation, but such cancellation shall not alter any obligation of the undersigned arising hereunder prior to receipt of written notice.3) Guarantor agrees to pay all of the Seller’s costs and expenses, including but not limited to attorneys’ fees, legal expenses, & collection agency fees, incurred by the seller in collecting amounts owed by Applicant, in enforcing any term of the sales agreement, in responding to defenses, a�rmative defenses, arbitration, and/or counterclaims raised by Applicant and/or Guarantor, and/or enforcing any term of this personal guarantee.4) The undersigned further acknowledges and represents that any titles written near the signatures below is/are intended merely to clarify the individual’s position with the Applicant and in no way is intended to limit or cancel the personal nature of this guarantee.

THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICANTS ON THE BASIS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, SEX, MARITAL STATUS, AGE (PROVIDED THE APPLICANT HAS THE CAPACITY TO ENTER INTO A BINDING CONTRACT); BECAUSE ALL OR PART OF THE APPLICANT’S INCOME DERIVES FROM ANY PUBLIC ASSISTANCE PROGRAM OR BECAUSE THE APPLICANT HAS IN GOOD FAITH EXERCISED ANY RIGHT UNDER THE CONSUMER CREDIT PROTECTION ACT. THE FEDERAL AGENCY THAT ADMINISTERS COMPLIANCE WITH THIS LAW CONCERNING THIS CREDITOR IS THE FEDERAL TRADE COMMISSION, EQUAL CREDIT OPPORTUNITY; WASHINGTON, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the speci�c reason for the denial. To obtain the statement, please contact Paci�c Plumbing Supply Company LLC, Attn: Credit Department, 7115 W Marginal Way SW, Seattle WA 98106-1911 within 60 days from the date you are noti�ed of our decision. We will send you a written statement of the reason(s) for the denial within 30 days of receiving your request for the statement.

Signature:

Please print or type your name & title

Date: Signature:

Please print or type your name & title

Date:

PERSONAL GUARANTY

Signature Date

Please print/type name

Address

City, State, Zip

Signature Date

Please print/type name

Address

City, State, Zip

Page 2 of 3

Administrative O�ces7115 W Marginal Way SW

Seattle, WA 98106Phone: 206-762-5920

Fax: 206-762-5928“The Service People!”

1949

Revised Date: 05/24/2017

If you have not listed Principal Credit sources on the �rst page of this application or if your �rm has been in business less than 6 months, please �ll out the following Financial Statement. For the purpose of securing credit accommodations, the undersigned represents and warrants that the followinginformation is true, and that it is given with the intent that it shall be relied upon in making a decision as to the advisability of extending credit to the undersigned.

Signature

Social Security Number

FINANCIAL STATEMENT

Page 3 of 3

Description: Home, du-plex, apt, car or truck

Assets Liabilities

Cash in bank & on hand

Accounts Receivable

Inventory of material ofmerchanside at cost.

$

$

$

Other Assets (Itemize Please)

$

$

$

$TOTAL ASSETS

Accounts Payable

Notes Payable

Total

$

$

$

Other Debts or Liabilities (Itemize Please)

$

$

$

$TOTAL LIABILITIES

NET WORTH (TOTAL ASSETS MINUS TOTAL LIABILITES) ……………………………………………………………

What Portion of the liabilities is past due? …………………………………………………………………………

Sales last year Expenses last year

Name of your Bank and Branch

Description: Home, du-plex, apt, car or truck

REAL ESTATE AND VEHICLES UPON WHICH YOU ARE MAKING PAYMENTS.

$

$

Should you wish to verify any of the information I have listed concerning the real estate or vehicles I am making payments on, I authorize you to obtain such information from the mortgage or contract holders.

$$

1.

2.

3.

4.

Description: Home, du-plex, apt, car or truck

Real estate address; Ye-ar Make & Model of ve-hicle

Approximate Dollar Amount of monthly Payments

Approximate Number of years you have been paying balance.

Approximate Balance Mortgage or Contract Holder name & phone number

Account number of mortage or contract