Customer Credit Application smionline.com
Text Box: TERMS: 1% 10 days, net 30, past due thereafter. 1-1 1/2% per month or 18% annual interest will automatically be charged on all past due accounts. Purchase signifies agreement with these terms.
Text Box: 1. Company Name:____________________________________________________________________ Street Address:________________________________________________________________________ Mailing Address:_______________________________________________________________________ City:___________________________________________ State_____ Zip Code________________ Telephone:(____)_______________________ Fax:(____)____________________________________ 2. Company is: a Partnership_____, a single owner_____, a corporation_____, other_____ Please list principals and titles. If partnership or single owner, please list their Social Security Number and home address. Name (please print)________________________Social Security Number_________________________ Title_________________________________________________________________________________ Home Address________________________________________________________________________ 3. Maximum line of credit requested $___________________ Years in business__________________ Estimated Gross Sales$___________________ Estimated Net Worth___________________________ 4. Credit references: No Financial Institutions Name of Company Mailing Address Phone Number a.___________________________________________________________________________________ b.___________________________________________________________________________________ c.___________________________________________________________________________________ 5. Name of your Bank:__________________________ City/State_______________________________ Banks phone number:________________________ Account No.________________________________ Bank Contact:______________________________ Title_______________________________________ 6. Name of person at your company to contact if there is a question on an order or invoice: A.__________________________________ B.______________________________________ 7. Is a purchase order or job number required on your invoices: YES_____ NO_____ 8. Is your company tax exempt? YES_____ NO_____ If yes, send copy of resale/tax exempt permit The above information is true and correct. I agree to your statement of terms as set forth above and agree to Pay any service charges as they accrue. Signature:______________________________________ Date:__________________________ Print Name: ___________________________________________________________________________
1401 40 th Street NW • Fargo, ND 58102 • Fax 701.281.1022