APPLICATION FOR CREDIT

 

Legal Name of Company :________________________________________________________

Address: ________________________________   

Phone: ____________________________

Fax:     ____________________________

City:   ___________________________________   State: ____  Zip: ________

D&B #: __________________________________  

Tax Exempt #: ______________________

 

Check One: _____ Proprietorship  

                  _____ Partnership

                  _____ Corporation  (State Incorporated _________)

                  _____ Other (Please Detail _______________________________)

 

Officers/Partners/Principals: (Or attach separate sheet)

Name: __________________________________  

Phone: (Direct Number) ______________________________

Title: ___________________________________   

 

Name: __________________________________  

Phone: Direct Number)______________________________

Title: ___________________________________         

 

Expected Monthly Dollar Volume: $________________________________ 

 

Expected Frequency of Orders: ___________________________________

 

Accounts Payable Contact: __________________

Direct Phone: ________________________

 

Credit and Bank References:  (Provide a separate list complete with contact name, phone and fax numbers)

 

I/We authorize the listed credit references to release information to

EAST SHORE INDUSTRIES, INC. DBA ALGOMA MOP MANUFACTURERS regarding my/our credit/financial status.

 

I/We do hereby agree to comply with credit terms set for by EAST SHORE INDUSTRIES, INC. DBA ALGOMA MOP MANUFACTURERS of   net 30  .

 

I/We acknowledge that service charges equal to the lesser of 1 1/2% per month or the maximum legal rate can be charged 1 (one) day from the date the invoice becomes due and payable, and a loss of "open account" status is automatic after an invoice is unpaid 45 days from the date the invoice becomes due and payable.

 

I/We agree to pay costs of collecting past due amounts including, but not limited to, actual attorney fees, collection fees and court costs.

 

By signing the Credit Application the signer agrees to the terms and conditions set forth.

 

Authorized Signature: _____________________________________   

Date: ______________________

Print Name & Title of Signer: ______________________________________