Credit Application and Agreement
□
Blumenthal Manufacturing Co.,
Inc.
□
Blumenthal Heavy Duty, Inc.
□
Blumenthal Automatics, Inc.
301 S. Western, Oklahoma City, OK 73109
504 SW 4th St., Oklahoma City, OK 73109
504 SW 4th St., Oklahoma City, OK 73109
(405) 232-9557
(405) 236-4800
(405) 236-4800
A.
APPLICANT
Legal Company Name:
____________________________________________________________________________________________________
Street Address:
__________________________________________ City:
__________________________ State:
_________ Zip: ____________
Mailing Address:
_________________________________________ City:
__________________________ State:
_________ Zip: ___________
Phone:
________________________________ Fax:
___________________________________ Email:
__________________________________
Ship to Address:
__________________________________________________________________________________________________________
Estimated Annual Sales:
________________________________________ Account
Contact Person: ___________________________________
Amount of Credit
Requested: $________________ Type
of Business: _______________________ How
Long in Business: ____________
B: BUSINESS INFORMATION
□
Sole Proprietorship _______________________________________________________ SS#:
___________________________________
□
Partnership Partner _______________________________________________________ SS#:
___________________________________
Partner _______________________________________________________ SS#:
___________________________________
□ Corporation/LLC
President / Manager _______________________________________ SS#:
___________________________________
Vice President / Member _______________________________________ SS#:
___________________________________
Secretary / Member _______________________________________ SS#:
___________________________________
Treasurer / Member _______________________________________ SS#: ___________________________________
Federal Tax No. (If
applicable) _______________________ Sales Tax Exemption Certificate □ Yes □ No (if Yes, enclose signed
certificate or copy)
C: BANKING INFORMATION
Bank: ______________________________ Branch:
________________________________ Phone:
______________________________
Street
Address: __________________________________________ City: __________________________ State: _________ Zip:
____________
Officer
Contact: _________________________________________ Acct. No.: _____________________ Type of Acct.: ___________________
Acct.
No.: _____________________ Type of Acct.:
___________________
I
hereby authorize bank named above to release information requested for the
purpose of obtaining and / or reviewing credit:
___________________________
Authorized Officer
D. TRADE REFERENCES (Please fill out 3 references)
Name Contact Address Phone
1. ________________________________________________________________________________________________________________
2. ________________________________________________________________________________________________________________
3. ________________________________________________________________________________________________________________
The
preceding information is for the purpose of obtaining credit and is warranted
to be true. I / we hereby authorize the above marked companies to investigate
all references and customary credit information sources including consumer
credit reporting repositories regarding my / our credit and financial
responsibility for the purpose of obtaining credit and for periodic review for
the purpose of maintaining the credit relationship.
CREDIT
POLICY: Statements are rendered as of Net 30 Terms, C.O.D.
restrictions may be placed on any past due account.
CREDIT
TERMS: All invoices are due Net 30 Terms. A service charge of one and on halve
percent (1˝%) per month, or 18% per annum, or the highest legal rate, which
ever is less may be assessed on delinquent invoices.
VENUE:
All amounts due for purchases from THE ABOVE MARKED COMPANIES are payable at
the address listed at the top of Page 1. It is further agreed that this
agreement is entered into in the state of Oklahoma and is governed by the laws
of the state of Oklahoma.
CHANGE
OF OWNERSHIP: I / We understand that I / we must notify The above marked
companies in writing and by certified mail of any change in ownership, the name
of the business or structure of the business under which credit is established.
In
the event of default, and if this account is turned over to an agency and / or an attorney for collection, the
undersigned agrees to pay all reasonable Attorney fees, and / or cost of
collection whether or not suit if filed.
I
/ We understand that each above marked company is an individual / separate
corporate entity doing business individually with me / us.
I
/ We certify that this request if for the extension of credit for business
purposes only and not for the extension of credit for personal, family or
household purposes.
APPLICANT’S
SIGNATURE: ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND
WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS.
Firm
Name: _____________________________________________________
By:
_________________________________ Title:
___________________________
By:
_________________________________ Title:
___________________________
CONSENT TO
OBTAIN CONSUMER CREDIT REPORT
The
undersigned individual who is either a principal of the credit applicant or a
sole proprietorship of the credit applicant, recognizing that his or her
individual credit history may be a factor in the evaluation of the credit
history of the applicant, hereby consents to and authorizes the use of a
consumer credit report on the undersigned by the above named business credit
grantor, from time to time as may be needed, in the credit evaluation process.
______________________________________ ______________________________________________ ___________________________
Print
Name Sign
Name Date
PERSONAL
GUARANTEE
For
valuable consideration, the receipt of which is acknowledged, including but not
limited to the extension of credit by the above marked companies to
__________________________________________________ the undersigned,
individually, jointly and severally, unconditionally guarantee(s) to the above
marked companies the full and prompt payment by
_________________________________________________________________ , of all
obligations which Guarantor presently or hereafter may have to the above marked
companies and payments when due of all sums presently or hereafter owing by
Guarantor to the above marked companies. Guarantor agrees to indemnify the
above marked companies against any losses the above marked companies may
sustain and expenses the above marked companies may incur as a result of any
failure of Guarantor to perform including reasonable attorney’s fees and all
cost and other expenses incurred in collecting or compromising any indebtedness
of debtor guaranteed hereunder or in enforcing this guaranty against guarantor.
This shall be a continuing Guaranty, Diligence, Demand, Protest or Notice of
any kind is waived. It shall remain in full force until guarantor delivers to
the above marked companies written notice revoking it as to indebtedness
incurred subsequent to such delivery. Such delivery shall not affect any of
guarantor obligations here under with respect to indebtedness heretofore
incurred.
The
undersigned personal guarantor, recognizing that his or her individual credit
history may be a necessary factor in the evaluation of this personal guarantee,
hereby consents to and authorizes the use of a consumer credit report on the
undersigned, by the above named business credit grantor, from time to time as
may be needed, in the credit evaluation process.
_______________________________________ ______________________________________________ ___________________________
Sign
Name Print
Name Date
_______________________________________ ______________________________________________ ___________________________
Sign
Name Print
Name Date
______________________________________________
Witness