Progressive Services Business Credit Application

1064 West Highway 50 Clermont, FL 34711 Phone: 352-394-0493
Business Credit Application
Customer or Business Name:
Address

Mailing Address

Street Address Line 2

CityState

Zip
(If more than one service address, please list on separate sheet.)
Purchase Orders Required
Service Contact:
Type of Business:
Business Phone

Area CodePhone Number
Fax

Area CodePhone Number
Email:
example@example.com
Accounts Payable Contact:
Phone Number

Area CodePhone Number
Fax

Area CodePhone Number
CorporationSole ProprietorPartnership
FEI#
Year Established
Dun & Bradstreet Number
Principle Owner’s or Officers:
1. Name/Title
Social Security #
Address
Phone Number

Area CodePhone Number
2. Name/Title
Social Security #
Address
Phone Number

Area CodePhone Number
Has the company or any officers, directors or owners of the company ever filed a voluntary petition in Bankruptcy, been adjusted? (If no, leave blank.)

Yes
If yes, who and when?
Financial Institution:
Address
Account Number:
Contact:
Phone Number

Area CodePhone Number
Credit References:
Creditor 1 Name
Creditor 1 Address
Creditor 1 Phone/Contact
Creditor 2 Name
Creditor 2 Address
Creditor 2 Phone/Contact
Creditor 3 Name
Creditor 3 Address
Creditor 3 Phone/Contact
I (We) acknowledge that the credit application information is true and correct. I (We) herby authorize the creditor to contact all credit references to inquire as to the credit information provided and give my consent for creditor to receive all confidential financial information that is relevant to approving our credit account. I (We) in making this application for credit, the customer acknowledges receipt of Progressive Services, LLC terms of Net 30-days and agree to pay all invoices within terms and pay a service charge of 1.5% per month, which is annual percentage rate of 18% of all overdue balances. In the event a suit is necessary to collect any amount, I (We) the customer agree to pay the sellers attorneys’ fees and cost including attorneys’ fees for appeal.
Owner/Officer Signature

Clear
Printed Name
Date

MonthDayYear
Date
PURCHASE AGREEMENT
As additional consideration for the sale of labor and materials by Progressive Services, LLC (also referred to herein as “Company” and “Seller”), whether accompanied by the extension of credit, applicant (also referred to herein as “Buyer”) agrees that the terms and conditions hereof shall apply to all transactions between the parties hereto. If signing as a corporate officer, the undersigned represents that the Board of Directors of the corporation authorizes this action.

If credit is extended, the applicant agrees to pay all invoices within thirty (30) days of the date of issuance. If the applicant fails to pay by the date due, it agrees to pay such additional service charges as specified herein.

If credit is not extended, the applicant agrees to pay Seller charges in advance of Service or COD at time of service. The Company reserves the right to extend credit requested herein and agrees to transact business with the applicant on the terms and conditions contained herein, whether credit is extended.

The applicant acknowledges that the Company will make a credit investigation and authorizes the applicant’s bank, credit and trade references to release information as requested by the Company.

The applicant agrees that all service orders placed with the Company and any materials purchased from the Company accepted by the applicant, shall be subject to the terms and conditions contained herein.

The applicant certifies that the foregoing information is true and correct and acknowledge that the Company’s determination of the applicant’s creditworthiness will be based to a significant degree on such information. The applicant further acknowledges receipt of a copy of this agreement.
Applicant
Authorized Signature

Clear
Title
Date

MonthDayYear
Date
Should be Empty:

Business Credit Application

PURCHASE AGREEMENT