All Uniform Wear Credit Card Application

Credit Application

All Uniform Wear 7190 SW 87 Avenue #207 Miami, Fl 33173
Store #:*
Date:*

MonthDayYear
Date
Credit Amount Requested:*
Terms:*
Salesrep Code:*
PH: (305)722-2188; Fax: (786)520-2994 CREDIT CARD DEPARTMENT
Company Information
Business Name:*
Street Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail address:*
example@example.com
Phone:*
Please enter a valid phone number.
Fax:*
Type of Business: Corporation Partnership* Individual*
Date Established:*

MonthDayYear
Date
State of Incorporation:*
Federal ID Number:*
Tax Certificate Number:*
Principal Owners (Primary Residence Information)
Name:*

First NameLast Name
Title:*
Phone:*
Please enter a valid phone number.
Address:*

Street Address

CityState / Province

Postal / Zip Code
Date of Birth:*

MonthDayYear
Date
SSN or Passport #:*
Driver's License #:*
State Issued:*
Additional Principal Owners (Primary Residence Information):
Name:

First NameLast Name
Title:
Phone:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:

MonthDayYear
Date
SSN or Passport #:
Driver's License #:
State Issued:
Bank References
Bank:*
Account #:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:*
Please enter a valid phone number.
Fax #:*
Account Type:*
Contact:*
Additional Bank References:
Bank:
Type a question
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
Please enter a valid phone number.
Fax #:
Account Type:
Contact:
Trade References
Company Name:*
Contact:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:*
Please enter a valid phone number.
Fax #:*
Account #:*
Terms:*
Additional Trade References:
Company Name:
Contact:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
Please enter a valid phone number.
Fax #:
Account #:
Terms:
Additional Trade References:
Company Name:
Contact:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
Please enter a valid phone number.
Fax #:
Account #:
Terms:
Additional Trade References:
Company Name:
Contact:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
Please enter a valid phone number.
Fax #:
Account #:
Terms:
All statements made herein are true and accurate to the best of our knowledge. I hereby agree to pay by the terms of sale listed on each of All Uniform Wear invoices All Uniform Wear reserves the right to charge a finance fee of one and on-half percent (1.5%) per each thirty day period. or part thereof, on any invoice that is past due. We further agree to pay all collection fees, reasonable attorney fees, court costs and other expenses incurred by All Uniform Wear to collect monies due.

Authorization is hereby given to release information to All Uniform Wear regarding our banking and credit history for the purposes of establishing credit. We hereby indemnify All Uniform Wear and its agent from any liability resulting from their credit survey. All information shall be held strictly confidential
Company Name*
Signature*

Clear
Print Name*
Title*
Date*

MonthDayYear
Date
Important: You MUST submit the following documents with this application: 1) a balance sheet 2) profit & loss statement for the last two years and 3) copy of sales tax exemption certificate.
Comments:*
Your prompt attention on this matter is greatly appreciated Any questions please do not hesitate to call us at (954)318-3007 & (954) 318-3008 Fax 19499 Sheridan Street, Pembroke Pines, FL. 33332 U.S.A.
Should be Empty:

Credit Application

Company Information

Principal Owners (Primary Residence Information)

Additional Principal Owners (Primary Residence Information):

Bank References

Additional Bank References:

Trade References

Additional Trade References:

Additional Trade References:

Additional Trade References: