Credit Application - Remee Wire and Cable

Credit Application

True Business Name*
DBA / Trade Name*
Resale #
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Fax
Legal Entity
We are a*
- Proprietorship
- Partnership
- Corporation
Established Since*
In the state of*
Corp ID#
Phone*
Email
Email Invoice
- Yes
- No
Principal
Name*
Title*
SS#*
Principal’s Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Banking Information
Bank*
Bank's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact*
Acct #*
Phone*
Trade References
Reference 1 Name*
Reference 1 Address*
City State / Province / Region ZIP / Postal Code
Reference 1 Phone*
Reference 1 Fax*
Reference 2 Name*
Reference 2 Address*
City State / Province / Region ZIP / Postal Code
Reference 2 Phone*
Reference 2 Fax*
Reference 3 Name*
Refrence 3 Address*
City State / Province / Region ZIP / Postal Code
Reference 3 Phone*
Reference 3 Fax*
Reference 4 Name*
Reference 4 Address*
City State / Province / Region ZIP / Postal Code
Reference 4 Phone*
Reference 4 Fax*
Terms and Conditions
I (we) acknowledge and agree as follows 1) that all accounts are due and payable according to the terms noted on each invoice. 2) Past due balances shall be subject to an interest charge of 1.5% per month from the date they are due, and payable through and including the date payment is received by Remee Wire & Cable 3) returned checks are subject to a $20.00 service charge. 4) I (we) agree to be personally liable for any and all reasonable costs incurred and collection costs, whether or not suit is filed. Payment of said costs is to be made not later than seven (7) days from the date Remee Wire & Cable provides documentation of same. 5) If legal action is filed I (we) agree venue will be Goshen, New York. 6) I personally guarantee payment of all sums due Remee Wire & Cable and certify that the statements and information contained herein are accurate and correct, and further authorize Remee Wire & Cable, or its agents, to investigate the references or other data furnished by the undersigned.
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Terms and Conditions
I (we) acknowledge and agree as follows 1) that all accounts are due and payable according to the terms noted on each invoice. 2) Past due balances shall be subject to an interest charge of 1.5% per month from the date they are due, and payable through and including the date payment is received by Remee Wire & Cable 3) returned checks are subject to a $20.00 service charge. 4) I (we) agree to be personally liable for any and all reasonable costs incurred and collection costs, whether or not suit is filed. Payment of said costs is to be made not later than seven (7) days from the date Remee Wire & Cable provides documentation of same. 5) If legal action is filed I (we) agree venue will be Goshen, New York. 6) I personally guarantee payment of all sums due Remee Wire & Cable and certify that the statements and information contained herein are accurate and correct, and further authorize Remee Wire & Cable, or its agents, to investigate the references or other data furnished by the undersigned.
Credit Line Requested $
Name*
Signature*
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