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-1- 10151 Stella Link Rd. Houston, TX 77025 Phone (713)661-6666 Fax (713)662-5542 Submitted By_______________________ Account #_________________________ Credit Application Please supply all information requested and return this application with a copy of your recent Financial Statement or other financial information, which would assist us in considering your request for credit. Any information provided will be held in strictest confidence and be used only for our credit granting purposes. The signature of Owner(s), Partner(s), or Corporate Officer(s) is required on the Continuing Guaranty for Corporations and/or Partnerships. Please return the completed application to the address listed above, Attn: Credit Department. I. APPLICANT INFORMATION: Company’s Legal Name_________________________________________ Name in Which Business Will Be Conducted_____________________________________ Billing/Mailing Address______________________________________________________ City___________________________State__________Zip_____________ Street/DeliveryAddress_______________________________________________________City___________________________State_________Zip______________ Phone______________________________Cell_____________________________Fax___________________________E-mail________________________________ Date Business Started _____________ Proprietorship Partnership Ltd Part Non-Profit Govt. Agency Corporation State __________Date __________ Address and Phone # of Home Office________________________________________________________________________________________________________ Annual Sales-Last Year: $___________________Year to Date: $_________________ Estimated Monthly Purchases from Johnson Supply: $_____________________ Number of Employees__________________ Have we ever sold to you, or to any present or former affiliate? Yes No If Yes, under what name and when?_________________________________________________________________________________________________ II. TYPE OF BUSINESS : A/C & Htg. Residential Replacement A/C & Htg Res New Const. A/C & Htg Commercial Geothermal Check all that apply: Refrigeration Sheet Metal Bldg. Maint. Apt. Maint. Industrial Institutional Comm. Controls International/Export Electrical Svc. Plumbing Svc. Modular Mfg Other_________________________ Contractors License Yes No O.D.C Permit Yes No E.P.A. Card Yes No Certificate of Registration Yes No If yes to any of the above, Please attach a copy of each. Permits must be provided in order to purchase refrigerant or equipment containing refrigerant. Do you have any unsatisfied judgments or claims against you? Yes No If yes, please provide the following information: Name of Creditor______________________________________________Amount of Judgment/Claim $________________________Date incurred________________ Case #______________________, Court where filed____________________________________________________________________________________________ Have you been a Debtor in a voluntary or involuntary bankruptcy case filled within the last ten (10) Years? Yes No Discharge Date __________________ If yes, please provide the Case #, Date Filed, and the court where filed. _____________________________________________________________________________ Do you pay by Statement Invoice? Is a Purchase Order Required? Yes No Are you tax exempt? Yes No Limited Sales Tax # ____________________ Please attach Certificate. Accounts Payable Contact _________________________________Phone #____________________Fax# _____________________E-Mail______________________ III. OWNERSHIP : List Complete Names of all Owner(s), Officer(s) or Partners Name & DL# Title % Owned Home Address Home Phone SS#

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Page 1: NEW CREDIT APPLICATION fAX clean v1 2 Application.pdf · 2009. 9. 15. · Credit Application Please supply all information requested and return this application with a copy of your

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10151 Stella Link Rd. Houston, TX 77025Phone (713)661-6666 Fax (713)662-5542

Submitted By_______________________ Account #_________________________

Credit ApplicationPlease supply all information requested and return this application with a copy of your recent Financial Statement or other financial information, which would assist usin considering your request for credit. Any information provided will be held in strictest confidence and be used only for our credit granting purposes. The signature ofOwner(s), Partner(s), or Corporate Officer(s) is required on the Continuing Guaranty for Corporations and/or Partnerships. Please return the completed application tothe address listed above, Attn: Credit Department.

I. APPLICANT INFORMATION:

Company’s Legal Name_________________________________________ Name in Which Business Will Be Conducted_____________________________________

Billing/Mailing Address______________________________________________________ City___________________________State__________Zip_____________

Street/Delivery Address_______________________________________________________City___________________________State_________Zip______________

Phone______________________________Cell_____________________________Fax___________________________E-mail________________________________

Date Business Started _____________ Proprietorship PartnershipLtd Part Non-Profit Govt. Agency Corporation State __________Date __________

Address and Phone # of Home Office________________________________________________________________________________________________________

Annual Sales-Last Year: $___________________Year to Date: $_________________ Estimated Monthly Purchases from Johnson Supply: $_____________________

Number of Employees__________________ Have we ever sold to you, or to any present or former affiliate? Yes No

If Yes, under what name and when?_________________________________________________________________________________________________

II. TYPE OF BUSINESS: A/C & Htg. Residential Replacement A/C & Htg Res New Const. A/C & Htg Commercial GeothermalCheck all that apply: Refrigeration Sheet Metal Bldg. Maint. Apt. Maint. Industrial Institutional Comm. Controls

International/Export Electrical Svc. Plumbing Svc. Modular Mfg Other_________________________

Contractors LicenseYes No O.D.C PermitYes No E.P.A. CardYesNo Certificate of RegistrationYesNo

If yes to any of the above, Please attach a copy of each. Permits must be provided in order to purchase refrigerant or equipment containing refrigerant.

Do you have any unsatisfied judgments or claims against you?Yes No If yes, please provide the following information:

Name of Creditor______________________________________________Amount of Judgment/Claim $________________________Date incurred________________

Case #______________________, Court where filed____________________________________________________________________________________________

Have you been a Debtor in a voluntary or involuntary bankruptcy case filled within the last ten (10) Years? Yes No Discharge Date__________________

If yes, please provide the Case #, Date Filed, and the court where filed. _____________________________________________________________________________

Do you pay byStatement Invoice? Is a Purchase Order Required? Yes No Are you tax exempt? Yes No Limited Sales Tax # ____________________Please attach Certificate.

Accounts Payable Contact _________________________________Phone #____________________Fax# _____________________E-Mail______________________

III. OWNERSHIP: List Complete Names of all Owner(s), Officer(s) or Partners

Name & DL# Title%

Owned Home Address Home Phone SS#

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IV. TRADE REFERENCE(S): Please provide the following trade references.

Trade Reference Address City, State, Zip Phone # (with area code) Fax # (with area code)

V. BANKING REFERENCE(S): Please provide the name, address, and contact information of your bank or banks.

Bank Reference Address City, State, Zip Phone #(with area

code)

Fax # (with area code) Account Number

To protect your company, please list employees who may purchase and sign for your company*. YOUR COMPANY WILL BE HELD RESPONSIBLE FOR ANYUNAUTHORIZED CHARGES IF THE LIST IS NOT SUBMITTED AND KEPT CURRENT.

__________________________________________ ___________________________________ ________________________________

__________________________________________ ___________________________________ ________________________________

*Attach a separate sheet for additional names.TERMS AND CONDITIONS

1. Definitions. “Seller”, “Johnson Supply” and “Company” is defined as Johnson Supply and Equipment Corp. and any of its subsidiaries, successors, and assigns. “Applicant” isdefined as, and includes, the firm or individual named on the top of the first page of this credit application, and all of his/her/its parent companies, subsidiaries, successors, heirs, assigns,executors, personal representatives and administrators, to the extent allowed by law. “Agreement” or “Application” is defined as, and includes, all the terms, conditions, and other informationcontained in this document. “Parties” is defined as, and includes, Seller and Applicant.

2. Application. With this Application, the undersigned Applicant hereby applies for credit to Seller, and in making this Application, the Applicant agrees to be bound by all of theterms and conditions contained in this Application, in any documents referenced by this Application or in any supplements to this Application. As a result of this Application or otherwise,should a credit availability be granted by Seller to the Applicant, all decisions with respect to the extension or continuation of credit shall be in the sole discretion of the Seller, and theApplicant shall be bound by all of the terms set forth in this Application as well as payment terms on any invoice of Seller, which are incorporated herein by reference. Notwithstandinganything contained herein to the contrary, the Seller may modify or terminate any credit availability at any time within its sole discretion.

3. Credit Report. In the event that the Applicant(s) is/are individual(s) or is a partnership, the signing of this Agreement shall constitute authorization under the Fair CreditReporting Act for the Seller to utilize consumer credit reporting agencies to provide reports on said individual(s) or partners in order to permit the Seller to appropriately evaluate the extensionof any business credit to the Applicant. Additionally, should any individual(s) guarantee the debt of the Applicant, said individual(s) shall be provided with a copy of this Application, and uponthe signing of said guarantee, shall consent to the Seller’s use of consumer credit reports to assist in the evaluation of the credit of said guarantor(s) for the extension of business credit to theApplicant.

4. Sole Agreement. No terms or conditions of purchase orders which are different from the terms of the Seller as contained in this Application or in any of Seller’s writtendocuments will become part of this Agreement or any sales agreement unless specifically approved in writing by the Seller. Applicant’s orders shall be deemed to incorporate the terms andconditions of this Application. In no event shall preprinted terms and conditions on any of Applicant’s documents, such as purchase orders, confirmations, acknowledgements, acceptances, etc.modify or add to the terms of an invoice or this Application.

5. Terms. With respect to any sales of goods or services by Seller to the Applicant on credit, the Applicant agrees that all amounts payable on or before the net due date as shownon each of the Seller’s invoices will be paid by the said net due date, and if not paid on or before said net due date, will then automatically deemed to be delinquent (a “Delinquency”). If no duedate is listed on an invoice, terms for that sale will be net 30 days. Unless otherwise specified by Johnson Supply in writing; all sales are F.O.B. Shipping Point. ALL CLAIMS FOR WRONGSHIPMENT MUST BE MADE WITHIN FIVE DAYS FROM THE DATE OF DELIVERY; POSITIVELY NO GOODS WILL BE ACCEPTED FOR RETURN UNLESS WRITTENAUTHORIZATION IS FIRST OBTAINED FROM OUR OFFICE. The customer must file claims for goods, damaged or lost in shipment directly with the freight company. Goods must beexamined immediately upon receipt and any claims filed within the time allowed by the freight company. All accounts shall be due and payable at P.O. Box 973777 Dallas, TX 75397-3777.

6. Finance Charge. It is understood that the Seller may impose and collect a finance charge, which charge will be the lower of (a) one and one-half percent (1 ½) per month or (b)the highest rate allowed by law, and may be imposed on any amount which becomes a Delinquency. Additionally, the Applicant agrees to be liable to the Seller for all internal and externalcollection costs, attorney’s fees and Court costs of the Seller in connection with any Delinquency placed for collection by the Seller.

7. Warranties JOHNSON SUPPLY MAKES NO WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTY OF MERCHANTABILITY ORFITNESS. THE ONLY WARRANTY WHICH WILL APPLY TO THE MERCHANDISE OR MATERIAL SOLD BY JOHNSON SUPPLY IS THE WARRANTY MADE BY THEMANUFACTURER. SELLER’S REPRESENTATIVES ARE WITHOUT AUTHORITY TO CHANGE THE FOREGOING. JOHNSON SUPPLY IS NOT RESPONSIBLE FORANY DIRECT, INDIRECT OR CONSEQUENTIAL DAMAGES TO THE USER OF ANY MERCHANDISE OR PRODUCT SOLD. NO CREDITS WILL BE ISSUED WITHOUTTHE SELLER’S PRIOR WRITTEN APPROVAL. ALL RETURNS MAY BE SUBJECT TO A RESTOCKING CHARGE. THE APPLICANT SHALL NOT USE THE NAME,TRADE NAMES OR LOGOS OF THE SELLER WITHOUT THE SELLER’S WRITTEN CONSENT.

8. Choice of Law, Jurisdiction, and Venue. This Agreement shall be governed by and interpreted pursuant to the laws of the State of Texas and the United States of America,including, but not limited to, all conflicts of law rules. The Parties further agree that jurisdiction and venue of any claims arising under or relating to this Agreement shall be exclusive in HarrisCounty, Texas.

9. Waiver of Jury Trial. THE PARTIES HERETO KNOWINGLY AND INTENTIONALLY WAIVE THE RIGHT TO A JURY TRIAL ON ANY ISSUE ORDISPUTE THAT MAY ARISE BETWEEN THEM.

10. Condition of Equipment. Applicant further represents that he/she/it has inspected any property, goods, and/or equipment provided by Seller or has been given the opportunityto inspect same, and that upon his/her/its receipt of same Applicant acknowledges and expressly warrants that the property, goods, and/or equipment has been accepted in a good, safe, andserviceable condition.

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11. Applicant’s Representations. APPLICANT ACKNOWLEDGES AND UNDERSTANDS THAT ALL OF ITS REPRESENTATIONS CONTAINED HEREIN AREMATERIAL TERMS TO THIS AGREEMENT, AND THAT SELLER WILL MAKE ITS DECIS ION ON WHETHER TO EXTEND CREDIT IN RELIANCE UPONAPPLICANT’S REPRESENTATIONS HEREIN. APPLICANT WARRANTS THAT THE INFORMATION FURNISHED ON THIS APPLICATION IS TRUE AND CORRECT.APPLICANT AUTHORIZES SELLER TO INVESTIGATE ALL INFORMATION PROVIDED HEREIN AND HOLD FREE FROM LIABILITY ALL CREDITORS ANDOTHER PERSONS WHO MAY RESPOND TO INQUIRIES MADE BY SELLER. APPLICANT FURTHER AGREES THAT HE/SHE/IT HAS READ, ACKNOWLEDGED,AND UNDERSTOOD ALL THE INFORMATION, TERMS, AND CONDITIONS CONTAINED HEREIN. APPLICANT FURTHER AGREES THAT THE GUARANTYATTACHED HERETO SHALL APPLY TO, AND EVIDENCE THE GUARANTEE OF, ALL DEBTS OWED BY APPLICANT TO SELLER.

12. Miscellaneous. Any and all notices that may be necessary or required hereunder will be in writing and will be delivered by facsimile, a nationally-recognized overnightdelivery service, or certified mail. Notices will be sent to the address set forth in Section I herein. Notice will be deemed received upon receipt of confirmation of transmission when sent byfacsimile, or signing for receipt of delivery when sent by overnight courier or certified mail. The failure of either party to require performance of any right or remedy hereunder will not act towaive such right or remedy. If any term or provision of this Agreement or the application thereof to any person or circumstance shall to any extent be invalid or unenforceable, the remainderof this Agreement, or the application of such term or provision or circumstances other than those as to which it is invalid or unenforceable, shall not be affected thereby, and each term andprovision of this Agreement shall be valid an be enforced to the fullest extent permitted by law. This Agreement supersedes any prior or collateral agreements with respect to the subject matterhereof between the parties.

The person(s) signing this application (facsimile or stamped signature accepted as if it were an original) hereby certify that all of the information contained in this application andany attachment or amendment is true, correct, and complete to the best of their knowledge and belief. The information provided is the most current information available. I (We) herebyauthorize the firm to whom this application is made to investigate the references listed pertaining to my (our) credit and financial responsibility.

MUST BE SIGNED BY OWNER (S) OR AN AUTHORIZED AGENT OF THE COMPANY.

Company Name________________________________________________________________________________ Date _____________________________________

Signature_______________________________________________ Printed Name_____________________________________ Title___________________________

CONTINUING GUARANTY

For Value received, undersigned (whether one or more) jointly, severally and unconditionally guarantee the full and punctual payment when due of all indebtedness now or hereinafter owingby:____________________________________________________________________________________________________________________________________COMPANY NAME (Company name must be filled in above)

(hereinafter called “DEBTOR”, whether one or more) and its successors or assigns to Johnson Supply and Equipment Co. (hereinafter called ‘ COMPANY’) and its successors or assigns, tothe full extent of all purchases made by it from COMPANY, all services rendered to it by COMPANY and service charges on past due accounts with COMPANY plus any and all internal andexternal collection costs, attorney’s fees and Court costs for which DEBTOR may become liable.

This is a CONTINUING GUARANTY payable at the office of COMPANY in Houston, Harris County, Texas and shall not be wholly or partially satisfied by undersigned’spayment of any amount hereunder, but shall continue in full force and effect against each undersigned for the full amount of the indebtedness until he has actually delivered to an officer ofCOMPANY, at its office, a written revocation hereof, whereupon his liability as to any indebtedness subsequently incurred shall terminate, but he shall remain liable to the full amount withrespect to all indebtedness incurred. Undersigned waives notice of acceptance hereof, of the accrual, renewal and extension of the indebtedness, of DEBTOR’s default, and of the accrual ofundersigned’s liability hereunder.

The liability of any undersigned shall not be impaired, reduced or affected by the taking of any other security of guaranty for the indebtedness or by release, surrender,subordination or loss of any such other security or guaranty, or by COMPANY’s failure, refusal or neglect to collect the indebtedness from DEBTOR or to enforce or preserve any othersecurity or guaranty therefore, or by the release of any other undersigned from liability hereon, or by any other undersigned’s revocation hereof, or by death, insolvency, bankruptcy ordisability (such as infancy, covertures, insanity, or lack of corporate power) or DEBTOR or any other undersigned, whether now or existing or hereafter occurring.

Until revoked in the manner above specified, this guaranty shall bind each undersigned, his heirs, successors, executors and administrators as to the indebtedness incurred bothbefore and after his death and any other undersigned and shall inure to the benefit of COMPANY, its successors and assigns.

EXECUTED this______________________________ day of ________________________________, 20_______

Signatures of Owner(s), Partner(s), Corporate Officer(s) No Titles (facsimile or stamped signature accepted as if it were an original)

___________________________________________________ Home Address_______________________________________________________________________

___________________________________________________ Home Address _______________________________________________________________________

___________________________________________________ Home Address _______________________________________________________________________

Credit department use only

Credit Approved By_______________ Credit Declined by____________________ Date ________________ Terms _________ Credit Limit$______________Territory__________

REV. 07/07

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Credit Application Check List Below is a list of necessary information needed for the speedy processing of your credit application. Just to make sure that everything is included, please take a minute and complete this checklist before submitting the application. Keep in mind that all of this information is needed to be able to make a decision in opening a credit account. Once all of the information is included please fax it to our credit department at (713) 662-5542. Thank you for your prompt attention. _____ Complete company information (Date business started, business type) _____ Estimated monthly purchases from Johnson Supply _____ Copy of valid TACL Texas Air-Conditioning Contractors License (Texas State Law) _____ Copy of a valid EPA Card _____ Completed Sales Tax Exemption form or Resale Certificate _____ Accounts Payable Name and contact phone, fax, and email _____ Complete owner’s/corporate officer’s information (home address and phone number, social security number, drivers license number, and percentage owned) _____ Three complete trade references (including phone, fax number and account number) _____ Bank Reference (phone number, fax number, account number, and contact person) _____ Signature on Terms and Conditions, and on Continuing Guarantee Thank you for your interest!! Credit Department

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