CONFIDENTIAL CREDIT APPLICATION

CONFIDENTIAL CREDIT APPLICATION
Company Name:*
TAX ID (EIN):*
Mailing Address/Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Owner(s)*
Email*
example@example.com
Business Phone*
Fax#
Is Business Property:*

OwnedLeased
REFERENCES
Name of supplier
Email
example@example.com
Account Number
Phone Number
Name of Supplier
Email
example@example.com
Account Number
Phone Number
Name of Supplier
Email
example@example.com
I (we) understand McHutchison Inc.'s terms of sale is net 30 days unless otherwise discussed and that 2% per month (24% per annum) service charge will be added to any past due invoices. A fee of $25.00 will be charged for any returned check, declined EFT Transaction declined bankcard transaction. I (we) agree to pay accumulated service charges which are added to my (our) account (or the maximum permitted by law In the event of any default in payment I (we) agree to pay all collection costs including, but not limited to, attorney's fees, court costs, and collection fees. I (we) anticipate a credit requirement offrom McHutchison. I (we) further agree to supply an audited and current corporation statement (s) or a signed personal financial statement (s) if the amount of credit requested or the value of the merchandise ordered requires further investigation. If there are any changes in the business which would alter the credit status and/or ability to pay outstanding debts, I (we) agree to immediately notify McHutchison. I (we) also authorize McHutchison to obtain any further credit information they may deem necessary.
Authorized Signature:

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Date*

MonthDayYear
Date
Printed Name:
Title:
PERSONAL GUARANTEE
The undersigned, in consideration for the granting to the applicant of such credit as McHutchison in its sole discretion may from time to time deem appropriate, hereby (I) agree to the above terms and conditions. (ii) personally affirms that all of the above information is true, correct and complete and (iii) agrees to assume personal liability and responsibility for payment of the corporation’s account and personally guarantee payment of any monies to become due according to the above terms and conditions.
Authorized Signature

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Date

MonthDayYear
Date
Printed Name:
Title:
Credit Check Authorization
You are hereby authorized to release credit and loan information to McHutchison Inc. of Naperville, IL.
Signature

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Date

MonthDayYear
Date
Printed Name
Title
Customer Account Setup Form
Shipping Address

Billing Street Address

Street Address Line 2

Billing City / State / ZipState / Province

Postal / Zip Code
Phone
Email
example@example.com
Do you have multiple shipping addresses?

Yes (If yes, our customer service team will follow up to collect the full list of shipping addressesNo
Bookkeeper/ AP Contact Name
AP Email
example@example.com
AP Phone
Purchasing Agent Name
Email
example@example.com
Phone
How do you prefer to receive order confirmations & order changes?

Hard copy to billing addressEmail to purchasing AgentOther
How do you want to receive invoices & credit memos?

Email to bookkeeper/APEmail to purchasing AgentHardcopy to billing addressFax and/or email
How do you want to receive statements?

Email to bookkeeper/APHardcopy to billing addressOther
Should be Empty:

CONFIDENTIAL CREDIT APPLICATION

REFERENCES

PERSONAL GUARANTEE

Credit Check Authorization

Customer Account Setup Form