CREDIT APPLICATION
Billing/Shipping Information
Date
Company/Individual Name
Business Phone
Mailing address
Fax No.
City
State
Zip Code
Street Address
Cell Phone
Plumber License No.
Email:
Type of Business: ( ) Proprietorship
( ) Partnership
Fed ID/SS #:
( ) Corporation
( ) LLC
( ) Individual
Years in business:
Taxable: ( ) Yes ( ) No*
*Sales Tax Exemption Form must be enclosed
Name
Title
SS #
Address
City
State
Name
Title
SS #
Address
City
State
Name
Title
SS #
Address
City
State
Principals/Officers/Partners
Zip
Zip
Zip
Trade References (Preferably Suppliers)
Name
Acct #
City
State
Name
Acct #
City
State
Name
Acct #
City
State
Phone #
How Long
Fax #
Phone #
How Long
Fax #
Phone #
How Long
Fax #
BOTH PAGES OF THIS APPLICATION MUST BE COMPLETED BEFORE APPLICATION WILL BE APPROVED.
Business Banking References
Personal Banking References
Name
Name
Address
Address
Contact Person
Contact Person
Type of Account
Type of Account
Account #
Account #
Real Estate Owned
Market Value
Name of Mortgagor/Address
Title in Name of
Total Assets
Total Liabilities
Accounts Receivable Outstanding
Accounts Payable Outstanding
Estimated credit required
A/P Contact
PO’s required
( ) Yes
( ) No
Invoice/Statement preferences
Job Names required
( ) Email
( ) Yes ( ) No
( ) Fax
(If neither email nor fax is checked off statements will be mailed at the end of the month, invoices given at point of sale.)
The above information is for the purpose of obtaining credit and is warranted to be true. I/We authorize Dugan Supply Co., Inc. to investigate the
references listed pertaining to my/our credit history.
Dugan Supply Co. terms of sale are 2%10th, Net 30 days from statement date. Past due accounts will be subject to a finance charge of 1 ½% per month (18%
annually). I/We agree to the terms of sale and return policy for this company.
I agree to notify (the company),by certified mail, of all changes of ownership or changes in the legal structure of the aforementioned business within 30
days of said changes.
I agree to the above terms, the Terms of Condition of sales as stated on each (the company) invoice. I also agree to pay collection costs and reasonable
attorney fees on this account in the event it becomes overdue. If the account is turned over for collection, the 18% annual percentage rate will continue if/when suit is
filed and until account is paid in full.
APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND AGREEMENT TO PAY OUR INVOICES IN ACCORDANCE WITH THE
TERMS STATED.
**Signature/Title
Date
**Signature/Title
Date
INDIVIDUAL PERSONAL GUARANTEE
In consideration, of extending of credit, to the above company, at my request. I hereby guarantee to Dugan Supply Company, the prompt payment, when
due, of every claim and debt of the above company to Dugan Supply Co.. This Guarantee is given by the undersigned in order to induce Dugan Supply Co. to extend
credit to the above-named company.
For myself, my successors, heirs and assigns, I hereby agree to bind myself to pay Dugan Supply Co. on demand any sum which may be or become due to
Dugan Supply Co. by the company whenever the company shall fail to pay the same.
At its election and in its sole discretion Dugan Supply Co. may demand and collect payment of overdue amounts, 1 ½% per month-finance charge (18%
APR), costs and attorney’s fees on the above account from either the above company or the undersigned individually.
This individual Guarantee is continuing and may be revoked prospectively. The obligation of the undersigned is immediate and Dugan Supply Co. has no
obligation to proceed against the Applicant before first proceeding against the undersigned. Any such revocation to be effective must be signed and in writing.
Signature
Date
Signature
BOTH PAGES OF THIS APPLICATION MUST BE COMPLETED BEFORE APPLICATION WILL BE APPROVED.
Date