Sample Credit Application and Agreement Listing Terms and Conditions of Sale

This document is submitted for informational purposes only.  It should not be used unless and until it has been reviewed and approved by an attorney. 

CREDIT APPLICATION AND CREDIT AGREEMENT

Legal Company Name: _________________________________________________________________________                                                                    

Legal Address: ___________________________    City _____________________   

State ________   Zip ____________

Business Trade Name (if applicable)  _____________________________________________________________         

Contact information if we have questions regarding this application:                     

Name:  __________________Title: ______________  Phone: ___________________

Billing Address: ________________________________________________________________________________                                                      

City ______________________   State ________   Zip ____________

Accounts Payable Contact Person: ________________  A/P Phone #: ____________              

Ship to Address: ___________________________   City: _____________________   

State: ________   Zip: ____________                    

Estimated Monthly Purchases:   $________         Initial Order:  $  ________                                           

Years in Business  ________        Federal Tax ID Number ______________

Ownership Type:  Proprietorship,   Partnership,  Limited Partnership,  LLC,  (S) Corp,  (C) Corp,  Professional Corp,  Non-Profit Corp:   _____________________

REFERENCES:

Primary Bank/Financial Institution:  __________________________                                    

Account Number: __________  Bank Contact: ______________ Phone: ________________

Reference #1

Name: ____________________ Phone Number: ___________ Contact Name: ____________          

Reference #2

Name: ____________________ Phone Number: ___________ Contact Name: ____________          

Reference #3

Name: ____________________ Phone Number: ___________ Contact Name: ____________          

Attach Copy of Resale/Tax Exemption Certificate                                                  

Attach Copies of your three most recent, consecutive annual financial statements

Terms and Conditions of Sale

This section applies to all accounts with Name of Supplier.  Customer agrees to abide by Standard Terms of Sale published by Name of Supplier, as shown on Name of Supplier's invoices or statements, or by any written agreement or terms of sale with Name of Supplier governing Customer's account.  

Customer agrees to pay for all purchases, fees and other charges incurred by Customer or an authorized user on any account of Customer, including service charges on past due amounts at the highest rate permitted by law (including purchases billed to a third-party billing agent on behalf of Customer).  Without limiting Name of Supplier's other legal rights, Name of Supplier may exercise a right of setoff against amounts due Customer from Name of Supplier or any of its affiliates.  Name of Supplier reserves the right to change a payment term (including imposing cash payment upon delivery), limit total credit, suspend or discontinue the shipment of any orders to Customer if Name of Supplier concludes that (i) there has been a material change in the Customer's financial condition or payment performance or (ii) Customer has ceased or is likely to cease to meet Name of Supplier's credit requirements.

The signature below warrants that Customer has read and understands this form and has reviewed the information provided in its entirety and that all information is complete and correct, and agrees that Name of Supplier will be relying on this information and will notify Name of Supplier of any material changes to such information. Customer agrees to provide Name of Supplier with updated annual or quarterly financial statements upon request.   

Customer authorizes Name of Supplier, its employees, representatives, and agents (i) to investigate information provided, and Customer's credit, financial and banking records, (ii) and to obtain Customer's credit bureau report.  Name of Supplier is authorized to retain information obtained as part of the application process whether or not the requested account and/or credit is granted.  

This contract is governed under the laws of the State of California notwithstanding any conflict regarding choice of law. Disputes resulting in litigation will be adjudicated in a Court in the State of California notwithstanding any conflict over choice of venue for such litigation.  Customer agrees to pay all reasonable attorney fees and expenses or cost incurred by Name of Supplier in enforcing its rights to collect amounts due from Customer. By signing below, the undersigned authorized Name of Supplier to order a consumer report related to the business principal(s) to determine credit eligibility. It is understood and agreed that decisions relating to the extension of credit by Name of Supplier to Customer are made at the sole and absolute discretion of Name of Supplier.

Authorized Signature* ____________________   Print Name _____________________  

Title ____________________________   Date ______________

Submitted by Michael C. Dennis