The Lock Doctor, Inc. CREDIT APPLICATION |
The undersigned is applying for credit
with The Lock Doctor, Inc., and agrees to abide by the terms and conditions of The Lock Doctor, Inc. standard
contract. |
1. Company Name and Address | | |
| | |
| | |
2. Phone ( ) | | Fax
( ) | |
3. Federal
Tax ID or Social Security No. | |
4. Type of Business | | No.
of Employees | |
5. Date Business Established | |
6. Types of Products You Will Purchase | |
7.
Amount of Credit Requested $ | |
8.
Check which is applicable to you: |
o Corporation | o General Partnership | o Limited Partnership | |
o LLC | o Sole Proprietorship | o Other : _________________ | |
9. State where your company was organized : | |
10. Have you or any of your affiliates ever had credit with us
before or purchased from us before? Yes ___ No __ |
If yes, under what name? | |
11. Name or title of persons authorized to act on your behalf : | |
12. Trade References |
Reference #1 Name and Address : | |
| |
| |
| Phone ( ) | |
Reference
#2 Name and Address : | |
| |
| |
| Phone ( ) | |
13. Bank References |
Bank #1 Account # | | Phone ( ) | |
Contact Person | |
Name
of Bank | |
Address | |
Bank #2 Account # | | Phone ( ) | |
Contact Person | |
Name
of Bank | |
Address | |
14. Financial Information about your Company : |
Assets :
$ | | |
Liabilities: $ | | |
Approximate Annual Net Income:
$ | | |
15. Have you or your officers or affiliates ever filed a petition in bankruptcy? | |
16. Are you subject to any litigation? | | If so, describe here : | |
| |
| |
17. Are you current in meeting your
other financial obligations? | |
We declare that the above
information is true, correct and complete and is given to induce the Company to extend credit. We authorize
the Company to make such credit investigation as the Company sees fit, including contacting the above trade references and
banks and obtaining credit reports. We authorize all trade references, banks and credit reporting agencies
to disclose to the Company 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 those terms and conditions |
Name of Company | |
Authorized Signature : | |
Printed Name : | |
Title : | | Date : | |
GENERAL TERMS AND CONDITIONS 1. All bills become payable in full 30 days after receipt. If not paid by such time,
bills are considered past due. A service charge of 5% per monthly will be added to all amounts billed if not paid by the end
of the month, together with interest at the rate of 1½% per month. |
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