Credit Application Form

Credit Application Form

A Personal Guarantee is required to extend credit terms.
Section 1 - Business Information
Date

MonthDayYear
Date
Legal Business Name*
Business is a*

Sole ProprietorshipPartnershipCorporation
Federal ID#*
State*
Date of Inc.

MonthDayYear
Years in Business*
Section 2 - Owner Info / Contact Information
Owner Name*

First NameLast Name
Owner Social Security #*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner Cell Phone Number*

Area CodePhone Number
Owner Home Phone Number*

Area CodePhone Number
Business Fax Number*

Area CodePhone Number
Email*
example@example.com
Buyer Contact Info
Buyer Name

First NameLast Name
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Email
example@example.com
Accounting Contact Info
Name

First NameLast Name
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Email
example@example.com
Section 3 - Billing / Shipping Information
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Appointment Required*

YesNo
If Yes, With Whom?
Business Number*

Area CodePhone Number
Fax Number*

Area CodePhone Number
Section 4 - Online Ordering
Would you like access to our online ordering portal at www.compidistributors.com?*

YESNO
Web Purchaser Name

First NameLast Name
Web Purchaser Email
example@example.com
Email Order Acknowledgement

YesNo
Section 5 - Tax Exemption

Tax will be charged unless certificate is included
Sales Tax Exempt? (If YES you must attach a State Sales Tax Exempt Certificate & Sales Tax Exempt Form)*

YESNO
Upload a File

Cancelof
Resale Tax Number*
Section 6 - Invoice / Statement Requirements
PO Number(s) on Invoice*

YESNO
Job Number(s) on Invoice*

YESNO
Invoice Delivery Preference*

EmailFaxMail
Invoice Email
example@example.com
Monthly Statment Required*

YESNO
Monthly Statement Delivery Preference*

EmailFaxMail
Monthly Statement Email
example@example.com
Section 7 - Banking Information
Bank Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Bank Officer Handling Account*
Type(Check all that apply)*

SavingsCheckingLoan
Phone Number*

Area CodePhone Number
Fax Number*

Area CodePhone Number
Please furnish your latest financial statement with this application so that we may properly evaluate your account. All information furnished will be confidential.

Attach financial statement below*
Upload a File

Cancelof
Section 8 - Trade References

Fill In or Upload Trade References Below
Company
Name
Address
Title
Phone
Fax
Company
Name
Address
Title
Phone
Fax
Company
Name
Address
Title
Phone
Fax
I have trade references to upload* (If you filled out the above form then just check NO, or you can upload your Trade References instead here)
Upload Trade References?*

YESNO
Upload a File

Cancelof
Section 9 - Credit Requirements
I give permission to release information to Compi Distributors a division of Richelieu America, LTD. and any other credit bureau or agency contracted by Compi Distributors a division of Richelieu America, LTD. for the purpose of establishing a line of credit. Any information released to Compi Distributors a division of Richelieu America, LTD. will be strictly confidential.
Please Type your name (E Signature)*

Clear
Credit Limit Desired (Standard terms are Net 10th following month)*
Estimated Monthy Purchase Volume*
TERMS OF SALE - Net 10th Following Month

Unpaid charges thirty days from the date of delivery shall be considered past due and a finance charge will be added. The FINANCE CHARGE is computed at a periodic rate of 1 1/2 % per month or an ANNUAL PERCENTAGE RATE of 18% applied to the previous balance less payments or returns made during the current Billing Period. In the event that COMPI DISTRIBUTORS a Division of Richelieu America Ltd. is required to refer your account to collection, then in addition, you will be required to pay the fees from the attorney and/or collection fees incurred, for the collection of your account along with any court costs or other necessary and reasonable expenses incurred by COMPI DISTRIBUTORS a Division of Richelieu America Ltd. in collecting your account.

In consideration of any extension of credit by COMPI DISTRIBUTORS a Division of Richelieu America Ltd., either now or in the future, to the above named credit applicant, on the above terms, or any other terms agreed to by said credit applicant and COMPI DISTRIBUTORS a Division of Richelieu America Ltd., the undersigned, unconditionally, personally, jointly and severally guarantee the payment of any and all sums due or which may become due as a result of any such extension of credit.

By checking the box below next to your name(s), the undersigned acknowledges that he/she/they has/have read and understood all of the above and agrees to be fully bound by its terms.

Acknowledgement Required
Name of Applicant One*
Title of Applicant One*
I Agree*

YES
Please Type your name (E Signature)*

Clear
Other Notes/Comments
Enter the message as it's shown*
Should be Empty:

Credit Application Form

Section 1 - Business Information

Section 2 - Owner Info / Contact Information

Section 3 - Billing / Shipping Information

Section 4 - Online Ordering

Section 5 - Tax Exemption

Section 6 - Invoice / Statement Requirements

Section 7 - Banking Information

Section 8 - Trade References

Section 9 - Credit Requirements

TERMS OF SALE - Net 10th Following Month

Acknowledgement Required