(Required) Monthly Statement to be emailed to you? (Required) Yes (If YES indicate email Address below) No (USPS Mail) Do you: (Required) OWN RENT/LEASE RESELLER PERMIT #’S (All shipments to AZ, CA, NV or WA will be charged the appropriate sales tax unless
reseller permits are provided)– Please fax a copy of your permit with this application Please provide the following information as it applies to your company: CORPORATION? (Required) (If YES is indicated please complete the following): Yes No PARTNERSHIP? (Required) (If YES is indicated please complete the following): Yes No SOLE OWNER? (Required) (If YES is indicated please complete the following): Yes No
APPLICATION WILL NOT BE PROCESSED IF INFORMATION IS INCOMPLETE
Please list 3 references that extend your business a line of credit. Additionally, for business that rent/lease their
business property, you must include the landlord or lessor as a reference.
PERSONAL GUARANTEE TERMS
BALANCE IS DUE IN FULL BY THE 10TH OF THE FOLLOWING MONTH FOR
ALL CHARGES, OR THIRTY DAYS FROM THE DATE CHARGED.
I HEREBY AGREE TO PAY 1.5% PER MONTH SERVICE CHARGE (ANNUAL 18%) ON PAST DUE
BALANCE, INCLUDING ATTORNEY'S FEES AND COURT COSTS, IF ANY ARE INCURRED TO
COLLECT SAID BALANCE. ANY AND ALL APPLICANTS HEREBY WAIVES NOTICE OF ANY
DEMAND AS WELL AS ANY NOTICE DEFAULT.
For the purpose of obtaining credit the Customer represents that the information provided is true,
complete and correct.