CREDIT APPLICATION
Name of Business
*
Business Tax ID
*
Address
*
Street Address
City
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State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Email
*
Nature of Business
*
Date Established
*
Accounts Payable Contact
*
First Name
Last Name
Accounts Payable Email
*
Accounts Payable Phone Number
*
Format: (000) 000-0000.
Email for Invoices / Statements
*
Do you already have an Interior Supply sales contact?
*
Yes
No
If Yes, name of sales contact
First Name
Last Name
Which Interior Supply location will you be purchasing from?
Please Select
Akron
Altoona
Cincinnati
Cincinnati Doors
Cleveland
Columbus
Columbus Doors
Dayton
Dayton Doors
Detroit
Erie
Erlanger
Fort Wayne
Indianapolis
Indianapolis Doors
Lima
New Albany
New Albany Doors
Pittsburgh
Toledo
Whitestown
Youngstown
BUSINESS STRUCTURE
How is the business set up?
Business Structure
Corporation
Partnership
Sole Proprietorship
Is this a home-based business?
Yes
No
COMPANY PRINCIPALS
Who are the people in charge of business decisions?
Principal
*
BANK REFERENCE
Name of Bank
Branch Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Branch Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Checking Account Number
Savings Account Number
Loan Balance
Type of Loan
Loan Secured by
Loan Officer Name
First Name
Last Name
CREDIT REFERENCE
Please enter at least 3 references. Be sure to scroll to the right when filling in fields for each credit reference.
Credit References
STATEMENT OF ACCURACY
The undersigned, for the purpose of procuring and establishing credit from time to time with Interior Supply, Inc. hereafter referred to as Supplier and to induce Supplier to permit the undersigned Customer to become indebted to Supplier for the purchase of goods, materials, and/or services, furnishes the above business and personal credit information. The undersigned, (jointly and individually, if applicable) certify that all information in this Credit Application is complete, factual and correct, and understands that Supplier will rely on the accuracy of this information for any credit that may be extended. If any statement is not true in any material respect or if the Customer should file for bankruptcy or if any other creditor tries to seize the Customer’s property or if any adverse change occurs in the Customer’s financial condition, at the Supplier’s election, you may declare all of my indebtedness and obligations to you immediately due and payable without demand or notice. The undersigned hereby expressly authorizes Supplier to contact any parties listed by Customer herein for the purpose of verifying any information contained in this Credit Application. The undersigned hereby waives any right of privacy which it may have in any such information, and waives the effect and benefit of any statutes or regulations which give it the right to control or bar the releases of such credit information. Further, the undersigned hereby authorizes such parties to disclose to Supplier whatever information they may have with respect to the undersigned’s credit or financial status and hereby agree to hold such parties harmless for any such disclosure. If any representations made in this Credit Application are untrue, the undersigned agrees that all obligations of the Customer to, or held by, Supplier shall immediately become due and payable without demand or notice. The undersigned hereby acknowledges receipt of a copy of this Credit Application.
Statement of Accuracy Name
*
First Name
Last Name
Statement of Accuracy Signature
*
Date Signed
*
/
Month
/
Day
Year
Date
PERSONAL GUARANTY
As an inducement to you to grant credit, or assume a credit risk, from time to time, in respect of sales of goods, supplies or services made by you to:
Company Name
Hereinafter referred to as the “Customer” or in respect to any other type of transaction by which you may become the creditor of the Customer, the undersigned shall pay to you promptly when due, or upon demand thereafter without deduction for any claim of setoff or counterclaim of the Customer or loss of contribution from any co-guarantor, or any other defense, the full amount of all obligations or indebtedness due to you from the Customer, including interest, whether originating in transactions between you and the Customer, or assigned or transferred to you, together with all expenses of collection and/or reasonable counsel fees incurred by you by reason of the default of the Customer. This is a continuing guaranty, and shall be revocable only as to transactions entered into by you subsequent to the receipt by one of your officers of notice of termination sent by the undersigned by registered or certified mail. The undersigned waives notice of acceptance hereof, and notice of orders, sales, and deliveries to the Customer, and of the amounts and terms thereof, and of all defaults or disputes with the Customer, and of the settlement or adjustment of such defaults or disputes. The undersigned, without affecting his liability hereunder in any respect, consents to and waives notice of all changes of terms, the withdrawal or extension of credit or time to pay, the release of the whole or any part of the indebtedness, the settlement or compromise of differences, the acceptance or release of security, the acceptance of notes, trade acceptances or any other form of obligation for the Customer’s indebtedness, and the demand, protest, and notice of protest of such instruments or their endorsements. The undersigned also consents to and waives notice of any arrangements or settlements made in or out of court in the event of receivership, liquidation, readjustment, bankruptcy, reorganization, arrangement, or assignment for the benefit of creditors of the Customer, and anything whatsoever, whether or not herein specified, which may be done or waived by or between you and the Customer, or the Customer and any other person whose claims against the Customer have been or shall be assigned or transferred to you. The obligation of the undersigned is a primary or unconditional obligation, and covers all existing and future indebtedness of the Customer to you. This obligation shall be enforceable before or after proceeding against the Customer against any security held by you, and shall be effective regardless of the solvency or insolvency of the Customer at any time, the extension or modification of the indebtedness of the Customer by operation of law, or the subsequent incorporation, reorganization, merger, or consolidation of the Customer or any other change in the composition, nature, personnel, or location of the Customer. All liabilities of the Customer and of the undersigned shall mature immediately upon the insolvency of the Customer, the inability of the Customer to meet its obligations as they become due, the appointment of a receiver, custodian or trustee for the Customer or any of its property, the filing of a voluntary or involuntary petition for relief in bankruptcy, reorganization or arrangement, the making of an assignment for the benefit of creditors, or the calling of a meeting of creditors by the Customer or if any of the foregoing events shall occur with respect to the undersigned. Nothing herein contained shall be construed as an obligation on your part to sell goods or extend credit to the Customer or as an obligation to continue to sell goods or extend credit. Your records showing the account between you and the Customer shall be admissible in evidence in any action or proceeding involving this guaranty, and such records shall be prima facie proof of the items therein set forth. This guaranty shall for all purposes be deemed to be made in, and shall be governed and settled under the laws of the State where material is purchased. This guaranty shall be binding upon the undersigned, his/her legal representatives, and assigns, and shall inure to your benefit and to the benefit of your successors and assigns.
Personal Guarantor Signature
Date Signed
/
Month
/
Day
Year
Date
Name of Personal Guarantor
First Name
Last Name
Home Address of Personal Guarantor
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ATTACHMENT TO CREDIT APPLICATION
If non-taxable, you must include a copy of your blanket exemption form with this application. Individual exemption forms must be filed on each job, only if certain jobs are tax-exempt.
Taxable?
*
Taxable
Non-Taxable
If Non-Taxable, please upload your exemption form.
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Do you require a purchase order?
*
Yes
No
If Yes, what is the Authorized Purchaser's name?
First Name
Last Name
SUPPLY AGREEMENT
CREDIT APPLICATION submitted to INTERIOR SUPPLY INC. on the following date, and by the following customer.
Date
*
/
Month
/
Day
Year
Date
Name of Business
*
Terms & Conditions
TERMS Unpaid invoices are past due 30 days from date of invoice. LATE PAYMENT Past due accounts are subject to a late charge of one and one-half percent (1 1/2%) on the amount overdue. BAD CHECKS, C.O.D. A service charge of $30.00 will be applied to each returned check. If at any time, Customer fails to pay invoices when due, or if for any reason Supplier feels insecure in extending credit, Supplier may decline to provide further goods on credit. FAILURE TO PAY OR INSOLVENCY Failure by Customer to pay any part of the account when due, or in the event that proceedings in bankruptcy, receivership, or insolvency are instituted by or against Customer or his property, Supplier may at his option, cause the entire unpaid balance to become due immediately payable and Supplier shall have the right to enter at anytime without notice upon the premises where any of the materials procured by the Customer from Supplier are located. Customer hereby expressly waives any right to action which may accrue by reason of the entry for taking possession of or the selling of with respect thereto including service charges and reasonable attorney’s fees and court costs. Customer will be liable for all costs of collection and lawsuits, including but not limited to attorney fees, if necessary. This Credit Agreement shall for all purposes be deemed to be made in, and shall be governed and settled under the laws of the State where material is purchased. ADDITIONAL SECURITY FOR PAYMENT The Customer hereby agrees to execute such additional documents as the Supplier may require including a personal and/or business guaranty and UCC Financing Statements as required from time to time by the Supplier. ENTIRE AGREEMENT This Agreement covers all materials which the Customer may hereafter acquire at any time from Supplier. This Contract constitutes the entire agreement with Supplier. No waivers or modifications shall be valid unless the same are in writing and executed by the parties hereto. This contract shall apply and accrue to the benefit of, and be binding upon, the heirs, executors, administrators, successors, and assigns of the respective parties. RECEIPT OF A COPY Customer hereby acknowledges the receipt of a copy of the Agreement at the time of its execution.
Acceptance by Customer
Customer Signature
*
Customer Name
*
First Name
Last Name
Position
*
Date Signed
*
/
Month
/
Day
Year
Date
Submit
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