CONFIDENTIAL CREDIT APPLICATION

CONFIDENTIAL CREDIT APPLICATION
E-mail: AccountsReceivable@McHutchison.com Web: http://www.mchutchison.com
Company Name
Tax ID EIN
Address

Mailing Address

Street Address Line 2

City State ZipState / Province

Postal / Zip Code
Name of OwnerOfficers
Email
example@example.com
Phone
Fax
Is the business property:

OwnedLeased
REFERENCES
Name of Supplier
Full Address
Account Number
Phone Number
Name of Supplier
Full Address
Account Number
Phone Number
Name of Supplier
Full Address
Account Number
Phone Number
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.
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Printed Name
Title
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.
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Printed Name
Title
Return completed & signed application to: accountsreceivable@mchutchison.com or Fax (614) 319-6226
You are hereby authorized to release credit and loan information to McHutchison Inc. of Naperville, IL.
Company Name
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Printed Name
Title
Return completed & signed application to: accountsreceivable@mchutchison.com or Fax (614) 319-6226
Shipping Street Address
Shipping City State Zip
Phone
Email
example@example.com
Shipping Street Address
Shipping City State Zip
Phone
Email
example@example.com
Bookkeeper AP Contact Name
Phone
Email
example@example.com
Purchasing Agent Name
Phone
Email
example@example.com
How do you prefer to receive order confirmations & other changes?

Email to purchasing agentHard copy to billing addressFax/email:
How do you prefer to receive invoices & credit memos?

Email to bookkeeper/APEmail to purchasing agentHard copy to billing addessFax/email:
How do you want to receive statements?

Email to bookkeeper/APHard copy to billing addressFax/email:
Upload your tax exemption form*

Cancelof
Click here if you need to complete and save the multi-jurisdiction sales tax exemption form
Should be Empty:

CONFIDENTIAL CREDIT APPLICATION

REFERENCES