Credit Account Application

I have spoken with an outside salesperson from Bill's Equipment & Supply. *

Yes

No

Salesperson's name: *

Business Info

Business Name *

DBA, if any

Mailing Address is *

Same as Physical Address

Different than Physical Address

Physical Address *

City *

State *

Zip *

Mailing Address *

City *

State *

Zip *

Phone *

Fax

Email Address *

Federal ID# *

State Tax# *

Principle Line of Work *

Yrs in Business *

Business Entity *

Payment Preferences

AP Contact Name *

I prefer invoices/statements by *

Fax

Email

Fax# *

Email *

I have a required signer list which I am providing *

Yes

No

Approved signers *

If more than 2 signers, attach list with authorized first and last names

I require a PO *

Yes

No

Principal Business Members

Principal Member #1 First Name *

Last Name *

Title *

Home Address

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Principal Member #2 First Name

Last Name

Title

Home Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Principal Member #3 First Name

Last Name

Title

Home Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Supplier Credit References

Supplier #1 *

Account # *

Phone Number *

Fax

Email Address *

Supplier #2

Account #

Phone Number

Fax

Email Address

Supplier #3

Account #

Phone Number

Fax

Email Address

Authorized Signature

The undersigned certifies that the above information is correct. Please be advised by signing this application you are authorizing the above references to release the necessary information to complete your credit application.

Authorized Signature *

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Name *

Company *

Date * +

Terms & Conditions of Credit

All proposals are subject to approval of our credit department.

Bill's Equipment & Supply, Inc. Terms are Net 30 from Statement, with a finance charge computed by a single periodic rate of 2% per month on balances unpaid 30 days after statement, which is an annual percentage rate of 24%. Customer will pay in US funds.

Collection costs applicable to all companies: Customer agrees to pay all collection costs and charges including repossession, court cost and reasonable attorney's fees.

All rentals and purchases hereunder made by Customer are subject to the then current agreements in effect.

GUARANTEE
The guarantor(s) do hereby unconditionally promise and guarantee the payment of any sum or balance that may now exist or hereafter be incurred with Bill's Equipment & Supply, Inc. This guarantee is made without limitation as to duration or amount and shall be a continuing guarantee covering all rentals and purchases.
(Sign below to acknowledge this agreement.)

Guarantee Signature *

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Applicant's Name *

Date (Click Calendar) * +