CR-Credit Application Form

Credit Application Form

Form 1 of 1

Please choose your preferred method of payment

Fintech is an easy, free & secure way to submit payment for all your purchases from Clare Rose. After your delivery is made the invoice will be electronically sent to Fintech for payment. Funds are then transferred directly from your bank to Clare Rose. Upon completion of this form, you will automatically be redirected to the Fintech website for easy signup.

If you apply for New York State Liquor Authority Credit Terms,

You MUST apply for Fintech.

Account Number:

Last Edited by:

Fintech*

YesNo

EFT - Using Fintech:*

Fintech - Next Day Payment (No Credit Check Required)Fintech - Payments made within New York SLA's payment terms (Credit Check Required)

Additional Payment Methods:*

Corporate CheckCertified Check/Money Order

Payment for Goods: Payment for goods sold is expected in accordance with the rules and regulations of the New York State Liquor Authority. Payment by business check will be accepted by Clare Rose Inc. as long as the account remains in good standing. In the event that three (3) checks are returned to Clare Rose Inc. for insufficient funds, Clare Rose Inc. will no longer accept checks from the account.

Provisions for Collection Expenses and/or Attorney's Fees: If any outside collection action is commenced by Clare Rose Inc. to recover payment due for goods sold and delivered, the undersigned agree(s) to pay an additional 25% of the amount owed in collection fees. If legal action is taken, applicant agrees to pay an additional 40% of the amount owed plus any and all attorney and court fees.

Guaranty of Payment: If licensee is a corporation, the undersigned agree(s) to be personally responsible for any merchandise sold and delivered to licensee by Clare Rose Inc. as if same were sold and delivered to undersigned. This is a guaranty of payment.

By signing this credit application, you give Clare Rose Inc. permission to run a personal credit report if credit terms are requested.*

I have read the above and agree to and accept all the terms listed in this application.

Corporation Name:

Doing Business As:

Name:

Home Address:

City:

State:

Zip:

Social Security #:

Cell #:

Email:

example@example.com

*PERSONAL GUARANTOR INFORMATION MUST BE FULLY COMPLETED AND SIGNED IN ORDER FOR A CREDIT REPORT TO BE RUN FOR CHARGE

(Personal Guaranty of Payment signature)

Date*

Date