Poems Art Publishing, LLC
4677 Cherry Street
Salt Lake City, Utah 84123
Phone: 801.747.1344
Fax: 801.747.1343
www.poemsart.com
Credit Application
Date
PLEASE COMPLETE AND FAX BOTH PAGES TO: 801.747.1343
We welcome your interest in doing business with Poems Art Publishing.
All information submitted will be held in strict confidence and used solely for reference within our credit department.
OWNERSHIP
Company Name _________________________________________________________
Address ____________________________________________________________________________________________________________________________
City/State/Zip ________________________________________________________________________________________________________________________
Phone (
) ______________________________________________________
Legal Status
Proprietorship
Partnership
Corporation
Email Address ________________________________________________
LLC
Type of Business ____________________________________________________
Year Established ____________________
Federal ID# ____________________________
Under Present Ownership Since _____________________
Company Owner ________________________________________________
Social Security # __________________________________________________
Owner’s Address ____________________________________________________________________________________________________________________
City/State/Zip ________________________________________________________________________________________________________________________
Owner’s Phone (
) __________________________________________
Owner’s Alternate Phone (
) ____________________________________
REFERENCES
1
BANK REFERENCE
Name & Branch ___________________________________________________________
Account #_________________________________________
Address/City/State/Zip ____________________________________________________________________________________________________________
Officer or Department ____________________________________________________________________________________________________________
Phone (
2
) __________________________
Fax (
) ____________________________
Email Address _________________________________
BUSINESS REFERENCE
Business Name ___________________________________________________
Contact Name/Title____________________________________________
Address/City/State/Zip ____________________________________________________________________________________________________________
Phone (
3
) __________________________
Fax (
) ____________________________
Email Address _________________________________
BUSINESS REFERENCE
Contact Name ____________________________________________________________
Title ______________________________________________
Address/City/State/Zip ____________________________________________________________________________________________________________
Phone (
4
) __________________________
Fax (
) ____________________________
Email Address _________________________________
BUSINESS REFERENCE
Contact Name ____________________________________________________________
Title ______________________________________________
Address/City/State/Zip ____________________________________________________________________________________________________________
Phone (
) __________________________
Fax (
) ____________________________
Email Address _________________________________
GUARANTEE
I, _____________________________________________ hereby authorize the release of all credit information to Poems Art Publishing, LLC. In consideration
of your extending credit at my request to ___________________________________________________ (hereinafter referred to as “Company”), of which I am
_____________________________________ (title), I hereby continually guarantee to you payment at Salt Lake City in the State of Utah of any obligation of
the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by Company whenever Company shall fail to
pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of Company. I do
hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. I,
the Buyer, also agree to report disputed items within ten days following date of invoice. I further agree that in the event of any default or delinquency by
Company, I will pay Poems Art Publishing, LLC, in addition to the outstanding balance, all collection fees up to 50% of the outstanding balance, all attorneys'
fees, court costs, and filing fees, and further agree that venue of any legal action shall be in Salt Lake County, State of Utah. I promise to execute, in behalf
of Poems Art Publishing, LLC, a UCC Security Agreement and any security interest in collateral or debts owed to Poems Art Publishing, LLC. If, at any time, my
account becomes delinquent, the above-mentioned agreements will be executed for the full balance of my account. No forbearance on the part of Poems Art
Publishing, LLC will be deemed as a waiver of their right to obtain such security and financing agreements from me. ALL ACCOUNTS OVER 30 DAYS WILL BE
CHARGED 1-1/2% INTEREST PER MONTH (18% per annum).
Name & Title (print legibly) ____________________________________________________________________
Signature ______________________________________________________
Date _____________________________
SALE & USE TAX
Company Name ____________________________________________________
I hereby certify that I hold a valid seller’s permit # ___________________________________ issued pursuant to the Sales and Use Tax Law, that I am engaged
in the business of selling art reproductions, and that the tangible personal property described herein which I shall purchase from Poems Art Publishing, LLC
will be RESOLD by me in the form of personal property: PROVIDED, however, that in the event any such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business. It is understood that I am required by the Sales and Use Tax Law to
report and pay for the tax measured by the purchase price of such property. The purchased items shall be for resale only.
Description of property to be purchased: Art Reproductions
Name & Title (print legibly) ____________________________________________________________________
Signature ______________________________________________________
Date _____________________________
I HAVE READ, UNDERSTAND, AND ACCEPT THE ABOVE TERMS, AND HAVE PROVIDED TRUE INFORMATION TO THE BEST OF MY KNOWLEDGE. I FURTHER
AUTHORIZE POEMS ART PUBLISHING, LLC TO VERIFY ANY AND ALL REFERENCES GIVEN THAT MAY BE REQUIRED TO DETERMINE CREDIT CAPABILITIES AND
TO REQUEST RELEVANT INFORMATION FROM CREDIT REPORTING AGENCIES.
Applicant Signature______________________________________________
Date__________________________________