CREDIT APPLICATION
Phone (707) 733-5214
Toll Free (888) 452-7796

The Stained Glass Web-Mart
PO Box 444
Loleta, CA 95551

 FAX (501) 621-4791
www.glassmart.com

The undersigned company is applying for credit with and agrees to abide by the standard terms and conditions of as printed on the These Pages.

Company name

DBA (if different)

Contact person

Address

Phone

Fax

Federal tax ID or Social Security number.

Type of business

No. of employees

Date business established

Types of products you will purchase

Amount of credit requested $

□ CORPORATION

State of incorporation

Names, titles, and addresses of your chief corporate officers

 

 

□ PARTNERSHIP

Names and addresses of the partners

 

□ SOLE PROPRIETORSHIP

Are you sales tax exempt?

□ Yes

□ No

Have you ever had credit with us before?

□ Yes

□ No

If yes, under what name?

Authorized purchasers 

Purchase order required?

□ Yes

□ No

 

TRADE REFERENCES

Reference #1

Name

Address

 

Phone

Reference #2

Name

Address

 

Phone

Reference #3

Name

Address

 

Phone

BANK REFERENCES

Bank#1

Account #

Name of bank

Phone

Contact person

 

Address

Bank#2

Account #

Name of bank

Phone

Contact person

Address

I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.

I have read the terms and conditions stated below and agree to all of these terms and conditions.

Authorized signature:

Printed name:

Title:

Date:

GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE

1. Payment is due upon receipt.
2. All bills become payable in full on the 11th day of the month and if not paid by the end of the month are considered past due.
3. A service charge of 5% per month will be added to all amounts billed if not paid by the end of the month.
4. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.
5. PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.