Credit Application

Credit Application

Circuit Breaker Guys Credit Terms
Company Name*
Phone Number*

Area CodePhone Number
D&B #
Fax Number*

Area CodePhone Number
Credit Amount Requested*
E-mail*
Company Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Type*

Sole ProprietorshipPartnershipCorporationOther

Business and Credit Info
Accounts Payable Contact*

First NameLast Name
Accounts Payable Phone*

Area CodePhone Number
Accounts Payable Fax

Area CodePhone Number
E-mail*
Company to Bill Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Phone Number*

Area CodePhone Number

Business References
Reference 1: Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Fax 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
Phone Number 2

Area CodePhone Number
Fax Number 2

Area CodePhone Number
Type of Account 2
Reference 3: Company Name
Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number 3

Area CodePhone Number
Fax Number 3

Area CodePhone Number
Type of Account 3

Agreement

(By checking these boxes you are agreeing to our terms - should you have any questions please contact us)
Agreement and Terms*

Excluding the opening buy special. All invoices are to be paid 30 days from the date of the invoice.
Agreement and Terms*

Any payment made via Credit card will include a 3% fee for processing.
Agreement and Terms*

Claims arising from invoices must be made within 7 business days of the invoice date.
Agreement and Terms*

Late Payment: Any payment not received within 15 days after the due date will be considered late. Late payments may be subject to a late payment fee of 1.5% percent per month, or the maximum amount allowed by law, whichever is less.
Agreement and Terms*

Default: If you default on any payment, Circuit Breaker Guys may suspend or terminate your credit account and may take any legal or equitable action to recover the debt
Agreement and Terms*

Credit Limit: A credit limit will be established based on your creditworthiness and payment history. The credit limit may be adjusted at any time at the discretion of Circuit Breaker Guys
Agreement and Terms*

By submitting this credit application, you authorize us to make inquires into the banking and buisness references that you provided.
Agreement and Terms*

If the Client is an LLC, Corporation, LLP or other entity, then the individuals signing this Agreement hereby agree to, jointly and severally as applicable, personally guarantee the payment and collection of all fees and costs payable under this Agreement, on behalf of said entity.
Enter the word as it's shown*
Signature

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Credit Application

Business and Credit Info

Business References

Agreement