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Trade
References: ALL three spaces must be filled in with
current open account creditors that allow your firm
to purchase $1,000.00 or more, within the last 12 months.
Company
Principals Responsible for Business Transactions.
Confirmation
of Information Accuracy and Release of Authority to
Verify.
The undersigned,
for the procuring and establishing credit from time
to time with Supplier to permit the above named customer
to become indebted to Supplier for purchase of goods,
materials, and/or services, furnishes the above business
and personal credit information. The undersigned,
jointly and individually, certify that all information
in this Credit Application is complete, factual and
correct, and understands the Supplier will rely on the
accuracy of this information for any credit that may
be extended. Supplier is hereby expressly authorized
to contact any parties listed herein and to verify any
information contained in this Credit Application.
The undersigned hereby waives any privacy of credit
information rights or regulations. If any representations
made on the Application prove to be untrue, the undersigned
agrees that all obligations of the above named customer
to, or held by, Supplier shall immediately become due
and fully payable without demand or notice, and the
undersigned further expressly agrees to assume personal
liability for all obligations of said customer to Supplier.
The undersigned hereby acknowledges receipt of a copy
of this Credit Application.
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