Rutherford Street Goleta CA 93117-3785 - Voice: (805) 964-8787 - Fax: (805)
CONFIDENTIAL BUSINESS ACCOUNT CREDIT APPLICATION
Name of Firm ___________________________________
Address ________________________________________City_____________ State/Zip
Phone__________________ Fax _________________ E- Mail ________________
Sole Proprietorship __ Partnership __ Corporation __Other (Specify) ____________
Date Incorporated or Established ________ Resale # ______________Contractors
Federal Tax I.D. # _________________
OWNERSHIP INFORMATION (Name of two principals or Officers if not Sole Proprietorship)
1. Name- __________________________ Title__________________________
Social Security # ________________ Date of Birth ______ Drivers License _____________________
Residence Address ___________________________City_____________ State/Zip _______________
2. Name __________________________ Title ____________________
Social Security # _________________ Date of Birth ______ Drivers License ____________________
Residence Address ___________________________City _____________ State/Zip _______________
1. Company Name _____________________________ Account # __________ Phone/Fax__________
Address ______________________________City _______________________ State/Zip
2. Company Name _____________________________ Account # __________ Phone/Fax
Address _________________________ City ___________________________ State/ Zip
3. Company Name ___________________________ Account # ____________ Phone/Fax
City __________________________ State/Zip ___________
BANK ACCOUNT INFORMATION
Name of Bank ______________________________________________ Branch ____________________
Address _________________________________ City ______________________ State/Zip
Checking Acct. # _________________________ Savings Acct. # ________________________
AUTHORIZED SIGNERS _________________________________________________________________
Do you use purchase orders? __________ Job Names? ________
By signing I (we) ask that an account be opened for myself/company.
In the event an account is opened for myself/company, I (we) agree to the following
terms and conditions:
1. INVOICE TERMS: Net 30 Days.
2. LATE CHARGES: 1.5% per month or maximum allowable rate. Minimum of
$.50 per month.
3. ACCELERATION CLAUSE: In the event the account becomes delinquent,
creditor reserves the right to accelerate and demand payment of the balance
in full, together with all accrued interest, late charges and costs of collection.
4. PERSONAL GUARANTEE: In the event of default, the undersigned officer(s)
agree to be jointly and severally liable for all amounts due therein.
5. COLLECTION FEES: In the event of default, I (we) agree to pay all
reasonable attorney's fees and costs incurred by creditor to collect all amounts
6. AUTHORIZED BUYERS: I (we) agree to be responsible for all purchases
made to this account by the authorized buyers above named and subsequently authorized
by us unless I (we) have notified you/creditor in writing, that said parties
are no longer authorized to charge to said account.
7. AUTHORIZATION TO CHECK CREDIT HISTORY: When making application, it
is understood that an investigation of my references and credit history will
be conducted, including information from credit reporting agencies.
DATE _________ SIGNATURE
(Authorized Officer Only)