VIP Customer Credit Application Form

Business Contact & Credit Information
Company Legal Name:
Sales Representative
For Company Use Only
Contact Name

First NameLast Name
Contact Phone Number
Main Phone Number
Email
example@example.com
In Business Since:

MonthDayYear
Date
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If Different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Structure

Sole ProprietorPartnershipLimited LiabilityCorporationOther
Business and Credit Information
Accounts Payable Contact Name

First NameLast Name
AP Contact Phone Number
Bank Name
Bank Phone Number
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business/Trade References

*Please provide a minimum of 2 references.
References List*
Credit Terms:

Credit Approval:
Credit is extended upon approval by the company. The applicant acknowledges that all information provided in the credit application is accurate and complete.

Payment Terms:
All invoices are due 10 days from the date of invoice unless otherwise agreed in writing. Any payment made after the due date may be subject to a 1.5% per month (18% per annum) late fee or the maximum allowable rate under state law, whichever is less.

Credit Limit:
A maximum credit limit will be determined by the company based on the applicant's creditworthiness and financial standing. The company reserves the right to adjust the credit limit at any time.

Methods of Payment:
Payments must be made via check, ACH transfer, credit card, or any other method as approved by the company. Any payment returned due to insufficient funds will incur a $30 NSF fee.

Late Payments:
Any overdue balance may result in the suspension of future deliveries or services. If payment is not received within 60 days, the account may be referred to collections, and the customer will be responsible for any associated fees, including legal costs.

Ownership of Goods:
Title to all goods supplied remains with the company until full payment is received. The company has the right to reclaim goods in the event of non-payment.

Disputed Invoices:
Any dispute regarding an invoice must be submitted in writing within 10 days from the invoice date. The company will review and resolve disputes in a timely manner. All undisputed amounts are still due by the invoice due date.

Financial Responsibility:
The undersigned agrees to personally guarantee payment in the event of default by the business unless otherwise stated in writing.

Collection Costs:
In the event that the company needs to refer an account to collections, the customer will be responsible for all collection costs, including any legal fees, court costs, and any other costs related to the recovery of outstanding amounts.

Right to Terminate Credit:
The company reserves the right to terminate or modify the credit terms at its discretion and at any time.

Need Help?

Contact us at: 972.316.7616 or email: accounting@vipsupplyco.com

Thank you for choosing VIP Supplyco!
Signature

Powered by Jotform SignClear
Should be Empty:

Business Contact & Credit Information

Business and Credit Information

Business/Trade References