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CREDIT APPLICATION Return via fax to 800-573-3630
■ Company Check (COD) ■ Credit Card How much credit are you applying for?
Telephone:________________________ Fax:______________________ Email: ________________________________________
Federal ID #: _______________________________________________________________________________________________ Tax Exempt number: _______________________________________ Yrs. In Operation: _______
Please send a copy of your tax exempt certi cate
REQUESTED TERMS
■ Open Account Security Agreement (Net) ■ Export ■ $500 ■ $1,000 ■ $2,500 Company Name: _____________________________________________ Website: _______________________________________
Filed for Bankruptcy: ■ No Retail – No. of Stores: ______ ■ Corp. ■ Proprietorship
■ Yes
■ Internet Based ■ Mail Order
■ Partnership ■ State/Fed Operation
Billing Address (Street): _______________________________________________________________________________________ City: ____________________________________________________________ State:_______________ Zip: __________________ Shipping Address (Street):_____________________________________________________________________________________ City: ____________________________________________________________ State:_______________ Zip: __________________
ACCOUNTS PAYABLE INFORMATION
Contact: ___________________________________________________________________________________________________ AP Telephone: ___________________________________ AP Fax:_____________________________________
AP Email Address:___________________________________________________________________________________________
FOR CREDIT CARD PAYMENT
Card Number:_____________________________________________ ■ AMEX ■ MasterCard ■ Visa ■ Discover Expiration Date:________________ CVV Code:________________
Bank Name:________________________________________ Bank Phone/Fax #: ________________________________________ Bank Address (Street): _______________________________________________________________________________________ City: ____________________________________________________________ State:_______________ Zip: __________________ Bank Account Numbers:___________________________________________ Contact: ____________________________________
TRADE REFERENCE
Company Name #1:_______________________________________________ Account No.: ________________________________ Phone:___________________________________________________________ Fax: _____________________________________ Address (Street): ____________________________________________________________________________________________ City: ____________________________________________________________ State:_______________ Zip: __________________
CREDIT/SECURITY AGREEMENT: The applicant named below here by applies for credit and supplies the information contained herein, which is warranted to be true and correct, for the purposes of introducing Lou Capece Music Distributors to extend credit.
It is agreed and understood that the undersigned is an authorized agent of the applicant and is duly empowered to enter into and
make binding agreements on its behalf; all invoice balances are due and payable within 30 days of receipt of the merchandise unless otherwise stated on the invoice; any invoice unpaid after the terms printed on the invoice is subject to a late fee of 1.5% per month;
in the event of default of payment when due, all costs of collection, including attorneys fee, whether suit led, will be paid by the applicant. Lou Capece Music Distributors will retain a security interest on the merchandise retained in the applicant’s place of business to offset any and all unpaid invoices owed Lou Capece Music. This agreement shall be governed exclusively by the New York State Law. Further, New York courts have exclusive jurisdiction to litigate any and all disputes between applicant and Lou Capece Music Distributors and applicant’s waives the right to change of venue. You are authorizing us to conduct a credit search as to the information provided. All the above mentioned in this paragraph of this Agreement are material parts of this contract and your signature on this form is acknowledgment and agreement to the content.
If late more than 15 days you agree that Lou Capece Music Distributors can charge your credit card the full amount owed.
FOR CREDIT CARD PAYMENT
Card Number:_____________________________________________ ■ AMEX ■ MasterCard ■ Visa ■ Discover
Expiration Date:________________ CVV Code:________________ Signature:______________________________________________________________ Date:_______________________________
Print Name:______________________________________________________
140 Lou Capece Music Distributors 800-321-5584 • 516-221-5596 • Fax 800-573-3630 | Order online: loucapecemusic.com
Credit Application