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: email@example.com
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 NAME: _______________________________ CONTACT: _________________________ ACCT#
PHONE: _________________________________ FAX: _________________________________
NAME & CONTACTADDRESSPHONEFAX
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 attorneys 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: