Credit Application for EES

Business Contact Info

Credit Application for EES Companies (Endurotech Chemicals; Endurobond Coating; Vortex Pump Barrels; Nature's Formula Fertilizer, D.R. Graham Trucking)
Company Name*
Trade Name*
Company Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Payable Contact*

First NameLast Name
Accounts Payable Contact E-mail*
Main Phone Number*

Area CodePhone Number
Main Fax Number*

Area CodePhone Number
Accounts Payable Phone Number*

Area CodePhone Number
Accounts Payable Fax Number*

Area CodePhone Number
FEIN
FEIN
Company Type*

Sole ProprietorshipPartnershipCorporationOther
Organization Home State
Organization Home State
Organization Establishment Date
Organization Establishment Date

Owners / Officers / Partners
Name*
Title
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Name*
Title
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Name*
Title
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Name*
Title
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com

Bank References
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Phone Number*

Area CodePhone Number
Contact at Bank
Contact at Bank
Email address for Contact at Bank
Email Address for bank contact
Account Number
Account Number
Type of Account
Type of Account

Business / Trade References
Reference 1: Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact
Phone Number

Area CodePhone Number
E-mail
Type of Account
Reference 2: Company Name
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact
Phone Number 2

Area CodePhone Number
E-mail
example@example.com
Type of Account 2
Reference 3: Company Name
Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact
Phone Number 3

Area CodePhone Number
E-mail
example@example.com
Type of Account 3

Questionnaire
Has "Company" or any of "Company's" owners, principals, partners, officers or directors ever filed a voluntary bankruptcy petition or made an assignment for the benefit of creditors?
If yes, explain
Has a lien or civil suit been filed against "Company", "Company's" property or any of "Company's" principals, partners, officers or directors within the past five years?
If yes, explain
Does "Company" operate under any other names?
If yes, please state the name(s)

Acknowledgement & Consent
Prices*

All sales made by EES to "Company" shall be made at the prices in effect at the time of sale. All quoted prices shall not include sales, use, excise or similar taxes that shall be billed and paid by the Buyer
Payment Terms*

Unless otherwise stated, payment terms shall be net 30 days from date of invoice. In the event that payment in full is not received by the 30th day from the date of invoice, EES shall charge a 1.5% late fee, accumulating monthly, or all outstanding balances. All accounts with balances 60 days past due will be placed on CREDIT HOLD. Accounts with a status of HOLD will not be re-opened until the account is paid current. Prepayment may be required before shipment or delivery to certain overdue accounts. EES reserves the right to refuse shipment or delivery if EES has reason to question "Company's" financial ability to pay its account balance. "Company" agrees to pay all costs of collection or securing or attempting to collect or secure any and/or all indebtedness to EES, including but not limited to attorneys' fees.
Disclaimer*

EES SHALL DELIVER ALL PRODUCTS IN AS-IS WHERE-IS CONDITION AND EES EXPLICITYLY DISCLAIMS ALL WARRANTIES, EXPRESS AND IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE
Acknowledgement and Consent*

In connection with this application, "Company" understands that an investigative inquiry may be made into "Company", including, but not limited to, verifying credit history, contacting business relationships, searching court records, and reviewing other information. "Company" authorizes investigation of all statements contained in this application as may be necessary in arriving at a decision regarding the "Company’s" creditworthiness. "Company" authorizes the obtaining of a credit report. "Company" authorizes release of reference from the references listed herein. "Company" further understands that for the purposes of this inquiry, various sources may be contacted to provide information, including but not limited to various Federal, State, County, municipal, corporate, private and/or other agencies, which may maintain records concerning the "Company’s" past activities relating to business conduct, court appearances, litigation, and credit performance, as well as various other information. "Company" hereby authorizes without reservation any company, agency, party, or other source contacted to furnish the requested information to EES. "Company" hereby releases,discharges, and indemnifies EES, EES’s agents, officers, directors, and employees, to the fullest extent permitted by law, from any claims, damages, losses, liabilities, costs, and expenses arising from the retrieving, reviewing, and reporting of the requested information. "Company" acknowledges that a photocopy of this authorization be accepted with the same authority as the original. The undersigned representative of "Company" warrants and guarantees that he/she is an officer, owner, or is otherwise authorized to contractually bind "Company", and the signature below does hereby legally bind "Company" to the terms and acknowledgments contained herein. "Company" hereby acknowledges and agrees that in the event a dispute arises out of or relates to "Company’s" application, business relationship with EES, or collection of "Company’s" account, the prevailing party in such dispute shall be entitled to an award of attorneys’ fees and costs associated with such action and/or disputere solution. Additionally, venue for any and all such disputes shall be exclusively in the state and federal courts located in Oklahoma City, Oklahoma. "Company" consents to personal and subject matter jurisdiction in such courts. "Company" shall indemnify, defend, and hold EES harmless from any and all claims, obligations, and liabilities of every kind arising out of or related to any inaccuracy, misrepresentation, or falsity contained in this application. In consideration for any extension of credit, "Company" agrees to the terms contained herein and authorizes any bank, supplier, creditor, loan agency, or similar institution to release any and all credit information to EES. "Company" acknowledges and assumes the risk that "Company’s" credit score may be affected due to EES’ investigation and validation contemplated herein.
Enter the word as it's shown*
Signature

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Should be Empty:

Business Contact Info

Owners / Officers / Partners

Bank References

Business / Trade References

Questionnaire

Acknowledgement & Consent