Credit Application | Great Lakes Fastening

Business Contact Information

Contact*

First Last

Title*

Phone*

Company Name*

FEIN*

Phone*

Fax

DUNS#*

Accounts Payable Contact*

First Last

AP Phone*

AP Email*

Registered Company's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Business Commenced*

Company Structure*

Sole Proprietorship
Partnership
Corporation
Limited Liability Company
Other, Please Explain

Other Explanation

Business Information

Primary Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long at Current Address?*

Phone*

Email*

Fax

Bank Information

Bank Name*

Phone*

Bank Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Account*

Business Checking
Business Savings
Personal Checking
Personal Savings
Other

Account Number

Business/Trade References

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Email*

Type of Account/Terms*

Business/Trade Reference 2

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Email*

Type of Account/Terms*

Business/Trade Reference 3

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Email*

Type of Account/Terms*

Agreement (Please mark each box stating that you agree to these terms)*

1.) All Invoices are to be paid 30 days from the date of the invoice
2.) A 7% Annual interest rate will be assed on payments past due. In addition, customer will pay attorney fees and collection costs incurred in collecting amounts owed.
3.) By submitting this application, you authorize Great Lakes Fastening to obtain a credit report and/or make inquiries to the banking and business trade references that you have supplied.
4.) Customers irrevocably submits to personal jurisdiction of any court located in Knox County, Tennessee and agrees that venue in such courts is proper in the event suit is filed to collect on this account.
5.) The Terms set forth herein shall supersede any different terms in any document provided by customer.

Acknowledgement (Please mark the box that you agree)*

By signing, you acknowledge that you are responsible for all invoices based on your signed bill of lading. If your order is missing a box or boxes or damaged and you did not notate the BOL, you will be responsible for the full balance of the invoice

Signature*

Name*

First Last

Title*

Email*

Phone*

Date*

Personal Guaranty (Please mark the box that you agree)*

The undersigned unconditionally guarantees prompt and full payment of all amounts owed on the account established by this credit application, including interest and attorney fees. This guaranty shall be continuing unless and until terminated by a signed written release. No extension of credit, increase of credit balance, waiver, release, or accommodation of the primary obligor shall affect the undersigned's obligation under this guaranty,

Signature*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country