New Account Application

NEW ACCOUNTS ONLY
PLEASE FILL IN ALL AREAS THAT APPLY
CONTACT NAME
COMPANY NAME
ADDRESS
CITY
STATE
ZIP
TELEPHONE
FAX
E-MAIL ADDRESS
example@example.com
THE ADDRESS ABOVE IS IT RESIDENTIAL?
TAX

YES(NO)
DRIVER LIC
TAX IF NO, FAX OVER RESALE CARD COPY TO CUSTOMER TO FILL OUT (IF NO RESALE #, CUSTOMER WILL BE TAXED UNTIL # IS RECEIVED) COD UNTIL CREDIT APPLICATION IS FILLED OUT AND APPROVED FOR TERMS.
DESCRIPTION / TYPE OF CUSTOMER
Example: Glass shop, Interior Designer, Furniture Designer, Furniture MFG, etc.
Annual sales expected wit PRL
Current glass / metal suppliers
Products of interest
Make customer aware that PRL offers SD Units, Entrance Doors, Glass Handrails, Architectural Metals, I.G. Units, Custom Glass Fabrication, Custom Mirrors, Spandrel Glass.
How did you learn about PRL

Magazine AdMailerWebTrade / Partners
Other
Please visit our website www.prlglass.com
DO NOT FILL IN. FOR ACCOUNTING DEPARTMENT ONLY
DATE INPUTED
ACCOUNT #
INPUTED BY
PF
RACK #
IF AN IMMEDIATE SALE IS PENDING, IT MUST BE PROCESS WITHOUT DELAY
IMPORTANT: Follow up with the person assigned to attend the call and make sure that the information is delivered to the caller satisfaction.
REPORT*
APROVED BY:
Please Fill In Application Completely
Firm Name
Address
City
State
Zip
Telephone
Fax
Type of Business
How Long
Taxable
Resale # Fax Singed Resale Card
Contract Lic #
Circle One of the Following

Corporation Partnership Sole Proprietor
Term Request
Credit Limit Request Dollar Amount
OFFICERS OF FIRM
1.
Position
2.
Position
Authotity To Sign Checks
D.L.
BANK REFERENCES
Bank
Branch
Phone
Acct.
CREDIT REFERNECES
1.Name
Phone
Address
Fax
2.Name
2.Name
Phone
Fax
3.Name
Phone
Address
Fax
I HERE BY CERTIFY THAT THE INFORMATION IN THIS CREDIT APPLICATION IS TRUE AND CORRECT. THIS INFORMATION INCLUDED IN THIS CREDIT APPLICATION IS FOR USE BY PRL GLASS SYSTEMS INC. IN DETERMINING THE AMOUNT AND CONDITIONS OF CREDIT TO BE EXTENDED. FURTHER I HERE BY AUTHORIZE THE BAN AND TRADE REFERENCES LISTED IN THIS CREDIT APPLICATION TO RELEASE THE INFORMATION NECESSARY TO ASSIST PRL GLASS SYSTEMS INC. IN ESTABLISHING A LINE OF CREDIT.
Sign
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Date

MesDíaAño
Fecha
By
Credit Card Payment Request
Date

MesDíaAño
Account #
Customers Name
Credit Card #
Numeric Part of Billing Address
Type of Credit Card
Zip Code
Last 3 Digits of Account
Reverse of Card (Visa and Discovery only)
Total Amount of Order
Order #(s)
Person Authorized to Use Card:
x
Signature

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Card Holders Name
Phone #
Fax #
GENERAL RESALE CERTIFICATE
California Resale Certificate
I HEREBY CERTIFY:
1. I hold valid seller’s permit number
2.I am engaged in the business of selling the following type of tangible personal property
3. This certificate is for the purchase from [Vendor’s name] of the item(s) I havelisted in paragraph 5 below.
[Vendor’s name]
4. I will resell the item(s) listed in paragraph 5, which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each item’s purchase price or as otherwise provided by law.
5. Description of property to be purchased for resale:
6 .I have read and understand the following:
For Your Information: A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale certificate to avoid payment to the seller of an amount as tax. Additionally, a person misusing a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is more.
NAME OF PURCHASER
SIGNATURE OF PURCHASER, PURCHASER’S EMPLOYEE OR AUTHORIZED REPRESENTATIVE

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PRINTED NAME OF PERSON SIGNING
TITLE
ADDRESS OF PURCHASER
TELEPHONE NUMBER
TELEPHONE NUMBER
DATE

MesDíaAño
Fecha
Individual Personal Guaranty
Dated

MesDíaAño
I,
Residing at
(Individual’s personal address, city, state, zip)
for and in consideration of
(Business Creditor’s Name)
extending credit to
(Name of Credit Applicant Company)
(hereafter referred to as the “Company”) of which and in reliance on any guarantyof said credit, I (Individual’s Name), hereby personally
(Individual’s Name)
guarantee to you the payment of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guaranty shall be a continuing and irrevocable guaranty, and indemnity for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. The Officer(s) of the Company must sing below as individuals – signatures only, no corporate titles.
SIGNATURE

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Print Individual’s Name
Date

MesDíaAño
WITNESS SIGNATURE

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Print Witness Name
Date

MesDíaAño
- 251 MASON WAY INDUSTRY, CA - 91746 PHONE: (626) 961 5890
- FAX: (626) 968 9256
Should be Empty:

NEW ACCOUNTS ONLY

TAX IF NO, FAX OVER RESALE CARD COPY TO CUSTOMER TO FILL OUT (IF NO RESALE #, CUSTOMER WILL BE TAXED UNTIL # IS RECEIVED) COD UNTIL CREDIT APPLICATION IS FILLED OUT AND APPROVED FOR TERMS.

IF AN IMMEDIATE SALE IS PENDING, IT MUST BE PROCESS WITHOUT DELAY

IMPORTANT: Follow up with the person assigned to attend the call and make sure that the information is delivered to the caller satisfaction.

Please Fill In Application Completely

Circle One of the Following

OFFICERS OF FIRM

BANK REFERENCES

CREDIT REFERNECES

Sign

Credit Card Payment Request

GENERAL RESALE CERTIFICATE

California Resale Certificate

I HEREBY CERTIFY:

Individual Personal Guaranty