ECODRAGON WHOLESALE CREDIT APPLICATION
please print and send to
PO Box 425 Portland, Maine 04112-0425
PHONE: 207-775-6900 • FAX: 207-775-6999 • E-MAIL:
info@ecodragon.com
COMPANY NAME
D.B.A.
BILLING ADDRESS ______________________________________ CITY _________________
STATE _____ ZIP
SHIPPING ADDRESS _____________________________________ CITY _________________
STATE _____ ZIP
PHONE __________________________ FAX ________________________ E-MAIL
TYPE OF ENTITY: ( SOLE PROPRIETOR ) ( PARTNERSHIP ) ( CORPORATION
) ( OTHER )
TAXPAYER ID # _________________ LENGTH OF TIME IN BUSINESS
TYPE OF BUSINESS
NAME(S) OF PRINCIPAL(S)/OFFICER(S) AUTHORIZED TO SIGN APPLICATION:
(1) NAME TITLE
HOME ADDRESS PHONE
(2) NAME TITLE
HOME ADDRESS PHONE
BANK REFERENCE:
BANK NAME: _______________________________ CONTACT: _________________________
ACCT#
ADDRESS:
PHONE: _________________________________ FAX: _________________________________
TRADE REFERENCES:
NAME & CONTACTADDRESSPHONEFAX
(1)
(2)
(3)
HAS AN APPLICATION EVER BEEN PREPARED OR FILED FOR BANKRUPTCY? NO _____ YES
_____
OUR TERMS OF SALE: Net 30 days. A finance charge of 1.5% per month will be added
to all charges past 30 days. This is an ANNUAL PERCENTAGE RATE OF 18%.
CREDIT AGREEMENT: After 90 days and if the matter is placed with an attorney
for collection, whether or not suit is brought hereon to enforce payment, we
agree to pay all costs of collection including a reasonable attorney’s
fee. In consideration of your extending credit the undersigned assumes full
responsibility for bills incurred as a result of this application.
I hereby authorize the above named firms and banking institutions to furnish
information requested by EcoDragon to process this application and I agree that
the said persons shall not be liable for any claim or damages as a result of
the requested information.
In the event that the above company/corporation cannot or will not meet its
financial obligation to pay any outstanding invoices, in accord with this credit
agreement, I (as a duly authorized owner or officer of the company) personally
guarantee such payment and performance according to the above terms.AUTHORIZED
REPRESENTATIVE (please print) _______________________________________ TITLE:
SIGNATURE _____________________________________________________________________
DATE: