CREDIT APPLICATION

Please provide the following company information:
Company Name
Address
City   St Zip
County   Country
Phone          Fax
E-Mail
D & B # Tax ID#
Please provide the following shipping information:
Street Address
City   St Zip
County   Country
Type of business Proprietorship Partnership    Corporation    Other
Owner's Name
Owner's SSN    Years in business
Please provide the following payables information:
Unit Manager
District Manager
Title
Phone

  
Address
City   St Zip
County   Country
Contact
Contact Title
Phone          Fax
E-mail
Please provide the following information for 3 trade references:
1.     Organization
Address
City   St Zip
Country      Phone
2.     Organization
Address
City   St Zip
Country      Phone
3.     Organization
Address
City   St Zip
Country      Phone
Please provide the following bank reference information:
Contact
Bank
Phone

 

Account #
Please provide the following preparer information:
Name
Title
Tax Exempt #

Enter estimated monthly amount of credit needed

I hereby represent that I am authorized to submit this application on behalf of the customer named above, and that the information provided is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize AMERICAN ASSOCIATED COMPANIES, INC. to investigate the references listed pertaining to my/our credit and financial responsibility. It is agreed and understood that all necessary collection and legal expenses and interest (at 1.5% per month) may be charged to debtor in the event of default or failure to pay for goods sold and delivered. I further represent taht the customer applying for credit has the financial ability and willingness to pay all invoices within established terms.  Payment(s) made beyond 30 days from date of invoice will be subject to finance charges of 1.5% of the unpaid balance.