Page 252 - Maintex Catalog

MAINTEX, Inc. CREDIT APPLICATION
13300 E. Nelson Avenue, City of Industry, CA 91746 • P.O. Box 7110 , City of Industry, CA 91744-7110 • PHONE (626) 961-1988 • FAX(626) 961-8730
Company Name
Street Address
Corporation
Sole Proprietor
Partnership
DUNS No. Phone No.
SALESPERSON
State of Incorporation
DateofIncorporation ___________________
If checked complete this section
Other
__________________
Business Premises: Own
For Sole Proprietor, Partnership or Nonpublic Corporation, complete the following: Principal's Name
City
ACC/PAY CONTACT
State
Zip Code
AMOUNT OF CREDIT REQUESTED?
Parent Company Name
Subsidiary Division
Street Address
City, State, Zip Code
Rent Lease (Terms of Lease _______________ Years)
Title
City, State, Zip Code
Home Address
Bank References
1. Name
Street Address
Type of Account: _________________ 2. Name
Street Address
Type of Account:: _________________ Credit References
1. Name
Street Address
2. Name
Street Address
3. Name
Street Address
4. Name
Street Address
Social Security No. Phone No:
Phone No: Date Opened
Loan No. ____________________________ Phone No:
Date Opened
Savings No.
___________________________ ____________________________
Checking No.
Checking No.
Contact Name
City, State, Zip Code
Savings No. ___________________________ Contact Name
City, State, Zip Code
Loan No.
Contact Name City, State, Zip Contact Name City, State, Zip Contact Name City, State, Zip Contact Name City, State, Zip
Code
Code
Code
Code
Phone No: Fax No: Phone No: Fax No: Phone No: Fax No: Phone No: Fax No:
Any prior history of bankruptcy or reorganization under bankruptcy laws?
Payment Terms: Net 30 days if credit is approved. Amounts past due will carry
a late charge of 1 1/2% per month or $3.00, whichever is more. Payment terms are subject to change and the invoice will reflect the prevailing terms.
Yes No If Yes, when? _____________________
Is this for RESALE? No Yes If Yes, please enclose a signed Resale card!
To the best of my knowledge the above facts are represented as true. If approved, we agree to your payment terms as shown above and to pay reasonable attorney/legal fees and/or collection agency fees if collection proceedings or litigation is required. My signature below indicates my/our permission for MAINTEX to obtain credit information from the sources referenced and any external credit reporting source. This agreement is entered into and is to be performed under the laws of the State of California, in the County of Los Angeles.
PERSONAL GUARANTY: Please read carefully before signing. In consideration of your extending credit to the above firm at my/our request, I/we hereby personally guarantee the payment of all of their obligations to you until withdrawn by me/us by certified mail. I waive all my rights of exemptions as to personal property under the laws and constitution of California or any other state against the collection of this debt.
Authorized Individual (Print)
Signature SSN
Da te
For Office Use Only
Billing Account Number
Credit Approved Yes No
Credit Limit
By: (Name) COD (Title)
Date
Date
T erms
Concurred by: (Name) (Title)
Go to maintex.com to fill out online.
Rev. 9/11