Credit Application PhoneThis field is for validation purposes and should be left unchanged.Business InformationLegal Business Name*Business Name / Doing Business As(if different than above)Date* MM slash DD slash YYYY Contact*Title*PhoneAddress Street Address Address Line 2 City State Zipcode Type of Business* Corporation Partnership Sole Propritorship Non/Profit Years in Business*Status of Business* New Established Number of Years*Resale Tax Certificate NumberStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificOwner/Principal Name*Home Address* Street Address Address Line 2 City State Zipcode Owner/Principal NameHome Address Street Address Address Line 2 City State Zipcode Do any unsatisfied judgments exist against business or principals? Yes No If yes, please explainHave you ever filed bankruptcy? Yes No If yes, please explainTrade References Trade Reference #1 *Name*Contact*Phone*Trade Reference #2 *Name*Contact*Phone*Trade Reference #3 *Name*Contact*Phone*Trade Reference #4NameContactPhoneTrade Reference #5NameContactPhoneResale Certificate and other information relevant to this application Drop files here or Select files Max. file size: 2 GB. In consideration for credit being extended, I or we acknowledge and agree to the following: Payment is jointly, severally and unconditionally guaranteed within 30 days of date of delivery. Any charges unpaid after the above 30 days are to be increased by 1 1/2% per month. Any charges still outstanding after 90 days from date of delivery are subject to collection and all collection or arbitration expenses, attorney's fees, and court costs will be borne by the purchaser. Title to all work shall remain with the creditor until all invoices and additional charges have been paid in full. All claims, requested for adjustments, or notification of error must be made within thirty days, or charges are considered accepted. This agreement shall apply to all current and future charges unless revocation is received by registered mail. Credit privileges may be withdrawn at any time without invalidating the terms of this agreement. Signature Δ
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