Belknap White Alcco

 

CREDIT APPLICATION

 (  ) BWA
(  ) Carpet Products Only
Please fax this completed form to (508) 337-2711.
Expected Credit Line:  $ Projected Sales Volume:  $
 
Business Name:
Billing Address: Phone #:
City: State: Zip: Fax #:
 
Shipping Address: Phone #:
City: State: Zip: Fax #:
 
Owner(s) Name SS#:
Address:
City: State: Zip: Phone #:
 
Owner(s) Name SS#:
Address:
City: State: Zip: Phone #:
 
Owner(s) Name SS#:
Address:
City: State: Zip: Phone #:
 
Bank Reference Account #:
Address: Contact:
City: State: Zip: Phone #:
 
Trade Reference* Contact:
Address: Phone #:
City: State: Zip: Fax #:
 
Trade Reference* Contact:
Address: Phone #:
City: State: Zip: Fax #:
 
Trade Reference* Contact:
Address: Phone #:
City: State: Zip: Fax #:
 
Trade Reference* Contact:
Address: Phone #:
City: State: Zip: Fax #:

* Use of mills only will delay processing of your credit application
 
(We/I) agree to the following conditions:
1.  All invoices will be paid according to your stated terms.
2. (We/I) will pay late payment charges which are computed by a "parlodic" rate of 1.5% per month which is an annual percentage of 18% applied to unpaid balances which are past due of the due date.
3.  (We/I) agree to pay collection costs and/or attorney's fees if placed for collection.
4.  (We/I) agree to notify you immediately of any changes of ownership.
5.  (We/I) authorize Belknap White Alcco to investigate my/our financial responsibility and credit worthiness with the understanding that personal credit reports may be drawn to aid in the evaluation for a commercial credit account as you deem necessary.
Date: Firm Name:
By:(Officer/Principal)
Please Check One: Date Business Started:
(   )  Corporation  Financial Statement Available:   (   )no      (   )attached
(   )  Partnership Tax Exempt Number:
(   )  Proprietor A copy of resale certificate must be attached.
Accounts Payable Contact: Phone #:
Is a monthly statement required?  (    )  yes       (    ) no

Personal Guarantee to
 Belknap White ALCCO
111 Plymouth Street, Mansfield, MA 02048 / 12 Commercial Road, Albany, NY 12205

The undersigned personally, jointly and individually guarantee payment in full to you of all indebtedness of the customer now existing or hereinafter incurred including any and all service charges, collection costs and attorney's fees incurred as specified on the preceding page, and waive any presentment, demand, protest, and any other notice regarding this guarantee of payment.  This guarantee with cover all sales whether or not the terms requested are COD.  The use of corporate titles shall not limit the personal liability of the signatory.  There are no legal impediment to my (our) signing this personal guarantee and accepting the obligations hereof.

The undersigned agree to immediately notify us of any change in ownership or address or form of said business.  This agreement shall remain in force until written notice of revocation is received by us.

_____________________________  
Witness		 X____________________________
_____________________________
Date		 X____________________________
X____________________________

Credit Department Use Only
D&B Credit Line Approved By Date
No application will be processed without the appropriate signature.