Credit Application for Business Account Form

Business Contact Info

Credit Application for Business Account
Company Name*
DBA (If Different)*
Company Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
Phone Number*

Area CodePhone Number
Fax Number*

Area CodePhone Number
Company Type*

Sole ProprietorshipPartnershipCorporation
How Long Under Present Owners?*
Officers/Owners
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Do You Own Business Property?

YesNo
If No, List Landlord Info Below
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Business and Credit Info
Accounts Payable Contact*

First NameLast Name
Accounts Payable Phone*

Area CodePhone Number
Accounts Payable Fax

Area CodePhone Number
E-mail*
Company to Bill Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Phone Number*

Area CodePhone Number
Account Type

CheckingSavingsLoan
Account #
Routing Number
Business References
Reference 1: Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail
Type of Account
Reference 2: Company Name
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number 2

Area CodePhone Number
Fax Number 2

Area CodePhone Number
Type of Account 2
Reference 3: Company Name
Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number 3

Area CodePhone Number
Fax Number 3

Area CodePhone Number
Type of Account 3

Repayment Agreement

In consideration of WCS Distributing, Inc. ("Seller") not requiring payment in full as items are purchased from Seller.
1. This Agreement shall cover all items of merchanise purcahsed by Buyer from Seller regardless of the date of purchase

2. This Agreement shall remain in full force and effect until revoked in writing. Any such revocation shall only be effective when sent by certified mail, return recipt request shall be effective propectively only and this agreement shall remain in full force and effect with respect to all items sold by Seller to Buyer up to and including date of recipt by Seller of written revocationof this Agreement

3. As to each item purchased by Buyer from Seller, the purchase price shall be due and payablenot later than the 20th day of the month following the date of purchase by buyer, unless otherwise stated

4. As to each item purchased by Buyer, which is not paid when due, there shall be added a montly service charge, not to extend the maximum rate of interest permitted by law and in no event greater than 2% per month on the unpaid balance of Buyer's obligation to Seller. In addition, in the event that said monthly services charge not paid by the 25th day of the following month, the monthly service charge shall be added on the unpaid balance an shall thereafter accrue a like service charge

5. In the event that Buyer shall fail to pay any of its obligation to Seller when due. Sellery may, at its options, terminate and obligation it may have to extend further accommodations to Buyer and may further accelerate and demand immediate payment in full of the balance of all Buyer's obligations to Seller

6. Buyer hereby waives to the full extent permitted by law and applicable statue of limitations and further agrees to pay to Seller all costs of collection incurred by Seller in collecting and indebtedness of Buyer to Seller. Without limiting the generality of the foregoing, there shall be included in costs of collection reasonable attorney's fees incudrred by Seller on collecting on any obligation owing to it by Buyer.
I Authorize WCS Distributing, Inc. To Investigate My Credit and/or Bank Records for the purpose of establishing a commercial line of credit.
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
I declare the statments made and financial information provided to be true and accurate to the best of my knowledge
Resale Certification
Name of Purchaser

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Seller Permit Number
My Permit covers the business of selling
Description of property to be purchased
For Your Information:

A person may be guilty of a misdemeanor under Revenue and Taxatino Code sectino 6094.5 if purchaser knows at the time of purchase that he or she will not resell the purchased Item prior to any use (other than retentino, 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.
I herby Certify That I hold the valid serllers permit issued pursuant to the sales and use tax law. These products will be resold by me in the form of tangible personal property; provided, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measure by the purchase of such property or other autorized amount.
Date

MonthDayYear
Date
Phone Number

Area CodePhone Number
Title
example@example.com
Signature

Clear
Should be Empty:

Business Contact Info

Officers/Owners

Business and Credit Info

Business References

Repayment Agreement

I Authorize WCS Distributing, Inc. To Investigate My Credit and/or Bank Records for the purpose of establishing a commercial line of credit.

Resale Certification