Credit Application

Business information

*Name of business
*Phone
*Fax
*Address
*City
*State
*Zip
*Nature of business
*Date established
*Resale tax or permit number
PO# required to receive payment
Tax exempt?
If you are tax exempt, please fill out and fax a signed copy of the Texas Sales Use Tax Exemption Certification
*Type of business

Corporation information

*Name of corporation

*Phone

*Fax

*Address

*City

*State

*Zip

Names of owners or officers

Bank information

Business references

Please list at least 2 local references
PLEASE NOTE THAT NO FOOD VENDORS OR UTILITIES WILL BE CONTACTED OR ACCEPTED AS TRADE REFERENCES
Reference 1:
*Name
*Address
*Zip
*Phone
Fax
*Person to contact
Reference 2:
*Name
*Address
*Zip
*Phone
Fax
*Person to contact
Reference 3:
Name
Address
Zip
Phone
Fax
Person to contact

Signature

Payment terms are net 30 days from date of invoice. If not paid in full by due date, purchaser expressly agrees to pay a service charge of one and one-half (1 1/2%) percent per month unless applicable laws require a lesser charge. Computed on the unpaid deliquent balance until the account is paid in full. In consideration for any credit which may be extended pursuant to the terms herof, purchaser agrees to to pay reasonable attorney fees and other cost incurred for collection.
Name of person filling out form
*I agree to these terms and conditions

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