Commissary Credit App

1615 Main Street Dallas, TX 75201 Phone: 214-696-7788 Email: RestaurantAP@headington.com

Commissary at 1217 Main Credit Application
Customer Information
Business Name
Company information
Your Name
Address

Address

Street Address Line 2

City State Zip CodeState / Province

Postal / Zip Code
DBA Trade Name
Shipping Address
City State Zip Code
Purchaser
Email Address
example@example.com
Email
example@example.com
Tax ID
Format: (000) 000-0000.
Banking information
Bank Name
Contact Person
Banking information
Phone number
Banking information
Address
Routing Number
Account Number
Trade Reference
Company Name
Contact
Trade referernce
Address
Contact Email
example@example.com
Contact Phone number
Format: (000) 000-0000.
Account Active Since
By submitting this application, you authorize Commissary and Headington Hospitality Employee Holdings, LLC (HHEH, LLC) to make inquiries into the banking/trade references that have been supplied. This agreement authorizes HHEH, LLC to initiate debit or credit entries to Customer's bank account and receive such funds in settlement of Customer's obligation with HHEH, LLC. Customer agrees and gives its approval to its bank or financial institution for HHEH, LLC to draft against Customer's account(s) and said bank or financial institution may rely upon executed copy of this Agreement without further authorization from the Customer.

All invoices are due and payable within 15 calendar days from the date of the invoice. A late fee of 3% per month may be applied to overdue balances, starting on the 16th day. If payment is not received within 30 days, the account may be subject to additional collection efforts and fees.
Signature of Owner or Officer

Clear
Printed Name and Title
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Should be Empty:

Customer Information

Banking information

Trade Reference