Page 88 - Alliance US FULL

CREDIT APPLICATION
26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
CREDIT APPLICATION
CREDIT APPLICATION
COMPANY INFORMATION: 26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
CREDIT APPLICATION
26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
CREDIT APPLICATION
800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
CREDIT APPLICATION
GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
Company Name (Legal, in full) or name of Individual (if sole proprietorship) 26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
COMPANY INFORMATION: 26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
26162 - 30A Ave, Aldergrove, BC, Canada V4W 2W5 T604.607.0908 F604.607.0903
COMPANY INFORMATION:
GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
Company Name (Legal, in full) or name of Individual (if sole proprietorship) 800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
COMPANY INFORMATION: name, list here (ie ABC Inc. dba Ace Pumping)
Tel incl area code
If company conducts business under a different trade 800 West Ridge Rd. Linwood, PA 19061 T610.584.7231 F610.584.7251
Fax
GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
Company Name (Legal, in full) or name of Individual (if sole proprietorship)
COMPANY INFORMATION:
COMPANY INFORMATION:
Company Name (Legal, in full) or name of Individual (if sole proprietorship) GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
Company Name (Legal, in full) or name of Individual (if sole proprietorship) Tel incl area code GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
Company Name (Legal, in full) or name of Individual (if sole proprietorship)
GST or FID/EIN/TIN# or SIN/SSN (if sole proprietorship)
If company conducts business under a different trade name, list here (ie ABC Inc. dba Ace Pumping)
Fax
Mailing Address City State/Prov Zip/Postal Code
If company conducts business under a different trade name, list here (ie ABC Inc. dba Ace Pumping) Tel incl area code Fax
If company conducts business under a different trade name, list here (ie ABC Inc. dba Ace Pumping) Tel incl area code Fax
If company conducts business under a different trade name, list here (ie ABC Inc. dba Ace Pumping) Tel incl area code State/Prov Zip/Postal Code
Fax
Mailing Address
City
Tel incl area code
If company conducts business under a different trade name, list here (ie ABC Inc. dba Ace Pumping)
Fax
Physical shipping address (if different) City State/Prov Zip/Postal Code
Mailing Address
City
Zip/Postal Code
State/Prov
Mailing Address City State/Prov Zip/Postal Code
Mailing Address City State/Prov Zip/Postal Code
State/Prov
Mailing Address
Zip/Postal Code
City
State/Prov
Zip/Postal Code
Physical shipping address (if different)
City
Credit line requested
Person Responsible for Accounts Payable
State/Prov
Physical shipping address (if different) E-mail for invoices City Are Purchase Orders required? Zip/Postal Code
Physical shipping address (if different) City State/Prov Zip/Postal Code
State/Prov
Physical shipping address (if different) E-mail for invoices City Are Purchase Orders required? Zip/Postal Code
Physical shipping address (if different)
Credit line requested
City
State/Prov
Zip/Postal Code
Person Responsible for Accounts Payable
Type of Business # of concrete pumps Annual Sales Yrs in Business
Person Responsible for Accounts Payable E-mail for invoices Are Purchase Orders required? Credit line requested
Person Responsible for Accounts Payable E-mail for invoices Are Purchase Orders required? Credit line requested
Credit line requested
Are Purchase Orders required?
Person Responsible for Accounts Payable
Annual Sales
Type of Business E-mail for invoices # of concrete pumps Are Purchase Orders required? Credit line requested
Yrs in Business
E-mail for invoices
Person Responsible for Accounts Payable
PRINCIPAL(S)/OFFICER(S) of the COMPANY:
Type of Business # of concrete pumps Annual Sales Yrs in Business
Type of Business # of concrete pumps Annual Sales Yrs in Business
Name Title Phone
Type of Business # of concrete pumps Annual Sales Yrs in Business
Type of Business
Yrs in Business
Annual Sales
PRINCIPAL(S)/OFFICER(S) of the COMPANY: # of concrete pumps
PRINCIPAL(S)/OFFICER(S) of the COMPANY:
Name Title Phone
PRINCIPAL(S)/OFFICER(S) of the COMPANY:
Name Title Phone
Title
Phone
Name
PRINCIPAL(S)/OFFICER(S) of the COMPANY:
PRINCIPAL(S)/OFFICER(S) of the COMPANY:
Name Title Phone
Name Title Phone
Title
Phone
Name
Title
Name
Phone
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
Name Title Phone
Name Title Phone
Name Tel Fax Contact
Name Title Phone
Title
Phone
Name
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
Name Tel Fax Contact
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
Name Tel Fax Contact
Name
Fax
Contact
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
Tel
TRADE REFERENCES (Please list principal suppliers of your business - Do NOT include Oil, Utility or Finance companies):
Name Tel Fax Contact
Name Tel Fax Contact
Fax
Tel
Name
Contact
Tel
Fax
Contact
Name
Name Tel Fax Contact
Name Tel Fax Contact
Name Tel Fax Contact
Name Tel Fax Contact
Contact
Tel
Tel
Contact
Name
Fax
Fax
Name
TERMS and CONDITIONS
Name Tel Fax Contact
Name Tel Fax Contact
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
Tel
Contact
Fax
Name
Name
Tel
Fax
Contact
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
TERMS and CONDITIONS
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
TERMS and CONDITIONS
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
TERMS and CONDITIONS
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
past due amounts. By Signing below, we (I) state that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
TERMS and CONDITIONS
TERMS and CONDITIONS
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
terms and conditions and agree to abide by them.
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
Credit may be extended after a detailed credit check is completed. We (I) hereby authorize Alliance Concrete Pumps Inc. and related companies to use personal infor-
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
past due amounts. By Signing below, we (I) state that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
mation to obtain credit information, from time to time, as may be deemed necessary in connection with this application. If credit is approved, a credit limit will be
Date (mm/dd/yy)
Title:
Signature of Owner or Company Officer:
Printed name:
terms and conditions and agree to abide by them. that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
past due amounts. By Signing below, we (I) state
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
established and may be revised or revoked, at our sole discretion, at any time. We (I) agree to pay all invoice amounts owing within stated credit terms (30 days from
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
past due amounts. By Signing below, we (I) state
terms and conditions and agree to abide by them. that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
date of invoice), and will accept service charges of 2% per month (26.8% per annum) on overdue balances. We (I) agree to pay all costs associated with collecting
past due amounts. By Signing below, we (I) state
terms and conditions and agree to abide by them. that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
Signature of Owner or Company Officer:
Printed name:
Title:
Date (mm/dd/yy)
past due amounts. By Signing below, we (I) state that the information contained herein is true and accurate and acknowledge that we (I) have read and understand the
In the event payment is not made I hereby agree to personally guarantee the unpaid obligations of the above company/ individual to Alliance Concrete Pumps Inc.
terms and conditions and agree to abide by them. Printed name: Title: Date (mm/dd/yy)
Signature of Owner or Company Officer:
terms and conditions and agree to abide by them.
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships) Title: Date (mm/dd/yy)
Printed name:
Signature of Owner or Company Officer:
Printed name:
Date (mm/dd/yy)
Title:
Signature of Owner or Company Officer:
Date (mm/dd/yy)
Printed name:
Title:
Signature of Owner or Company Officer:
In the event payment is not made I hereby agree to personally guarantee the unpaid obligations of the above company/ individual to Alliance Concrete Pumps Inc.
SIN/SSN:
DOB (mm/dd/yy)
Signature of Principal:
Printed name:
In the event payment is not made I hereby agree to personally guarantee the unpaid obligatio
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships) ns of the above company/ individual to Alliance Concrete Pumps Inc.
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships) ns of the above company/ individual to Alliance Concrete Pumps Inc.
In the event payment is not made I hereby agree to personally guarantee the unpaid obligatio
Printed name:
Signature of Principal:
SIN/SSN:
DOB (mm/dd/yy)
In the event payment is not made I hereby agree to personally guarantee the unpaid obligatio
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships) ns of the above company/ individual to Alliance Concrete Pumps Inc.
In the event payment is not made I hereby agree to personally guarantee the unpaid obligations of the above company/ individual to Alliance Concrete Pumps Inc.
Signature of Principal:
Printed name:
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships) SIN/SSN: DOB (mm/dd/yy)
and/or Alliance Concrete Pumps USA LP (MUST be completed for all sole proprietorships)
CREDIT DEPARTMENT USE ONLY Printed name: SIN/SSN: DOB (mm/dd/yy)
Signature of Principal:
Signature of Principal: Printed name: SIN/SSN: DOB (mm/dd/yy)
Signature of Principal:
SIN/SSN:
DOB (mm/dd/yy)
Printed name:
Credit report obtained and reviewed Reference checks completed Limit assigned Application approved by Customer contacted
CREDIT DEPARTMENT USE ONLY
CREDIT DEPARTMENT USE ONLY
Credit report obtained and reviewed Reference checks completed Limit assigned Application approved by Customer contacted
CREDIT DEPARTMENT USE ONLY
Comments
Credit report obtained and reviewed Reference checks completed Limit assigned Application approved by Customer contacted
CREDIT DEPARTMENT USE ONLY
CREDIT DEPARTMENT USE ONLY
Credit report obtained and reviewed Reference checks completed Limit assigned Application approved by Customer contacted
Credit report obtained and reviewed Reference checks completed Limit assigned Application approved by Customer contacted
Credit report obtained and reviewed
Customer contacted
Reference checks completed
Application approved by
Comments
Limit assigned
Comments
Comments
AR100-Credit_Application_v20101006
Comments
Comments
AR100-Credit_Application_v20101006
AR100-Credit_Application_v20101006
AR100-Credit_Application_v20101006
AR100-Credit_Application_v20101006
AR100-Credit_Application_v20101006