Instructions:

1) Print out this form
2) Fill it out, and sign it.
3) Mail it to us (we will NOT accept faxes).

Padre Janitorial Supplies - Application for Credit

Firm Name:

Delivery Address:

 

 

Billing Address:

Phone:

Fax:
Name of Parent Company (if subsidiary):

Management Company financially responsible for purchases:

Name:

Address:

 

 

Check one:
Franchisee
Corporation
Partnership
Sole Proprietor
Federal ID#:
Year Established:

At present location since:

 

Officers or Partners:

Name: Name: Name:
SS #:: SS #:: SS #::

Home Address:

 

 

 

Home Address:

 

 

 

Home Address:

 

 

 

Phone#: Phone#: Phone#:

 

Bank Information:

Name of Bank:

Address:

Branch:
Account#:
Phone#:

Check type of account:

Commercial
Loan
(type)

 

Credit References:

Name: Name: Name:
Acct #: Acct #: Acct #:
How long: How long: How long:

Home Address:

 

 

 

Home Address:

 

 

 

Home Address:

 

 

 

Phone#: Phone#: Phone#:

 

Purchase Order Numbers are required by this firm: Yes
No

Contact Persons:

Purchasing: Phone#:
Accounts Payable:

Phone#:

Fax#:

 

Resale Number:
Notice: If customer intends to resell merchandise purchased from Padre, a valid state reale card must be on file in our administrative office. Customer will be charged applicable state tax until such time as they have provided a completed document for our records. There will be no retroactive credits granted for purchase made prior to that receipt. Card mus contain a description of exempted materials for which resale is allowed in the course of business.

Terms:

Due and payable in 30 days. Grantor may impose a finance charge or deliquency charges of 1.5% per month on any amount which becomes past due and delinquent. The applicant shall be responsible for all collection costs and attorneys fees to enforce collection. The undersigned acknowledges and agrees that creditor may utilize outside credit reporting services to obtain information. In the event of litigation or arbitration, venue shall be in city and state of slae origination. The account will revert o a C.O.D. basis upon becoming past due. A fifteen dollar ($15) fee is charged for returned checks.

By completing this document, the applicant hereby authorized any of the above listed credit and/or banking referencs to release to Padre such credit information as they may deem required. I cerify that all information contained is accurate and correct to the best of my knowledge.

 

Signed

 

Title

 

print name

 

Date

 

Signed

 

Title

 

print name

 

Date