SAGER SPUCK STATEWIDE

SUPPLY CO., INC.

432 SOUTH PEARL ST., PO BOX 918, ALBANY, NY  12201

518-436-4711   FAX# 518-436-3532

 

APPLICATION FOR CREDIT

 

BUSINESS NAME: ______________________________________________________________________________________

D/B/A: _________________________________________________________________________________________________

BILLING ADDRESS: _____________________________________________________________________________________

DELIVERY ADDRESS: ___________________________________________________________________________________

TELEPHONE: ________________________________  FAX #: ______________________________________________

FEDERAL ID #: _______________________________    or SS#: ______________________________________________

TYPE OF BUSINESS: _____________________________         YEARS OF OPERATION: _____________

                (  ) CORPORATION    (  ) PARTNERSHIP    (  ) INDIVIDUAL                 PREMISES ARE  (  ) OWNED    (  ) RENTED

TAX EXEMPT: (  )YES (  )NO                  IF YES, PLEASE SEND COPY OF EXEMPT CERTIFICATE WITH APPLICATION

 

NAMES OF OFFICERS,                            __________________________________________________________________________

PARTNERS, OR INDIVIDUAL:                 __________________________________________________________________________

                                                                __________________________________________________________________________

A/P CLERK: ________________________________________                TELEPHONE & EXT: __________________________

CONTROLLER: _____________________________________                TELEPHONE & EXT: __________________________

BANK REFERENCES:

NAME OF BANK:_______________________________                CHECKING ACCOUNT #:______________________________

BRANCH:______________________________________                SAVINGS ACCOUNT #:________________________________

LOAN OFFICER:________________________________                COMMERCIAL LOANS ACCT#:_________________________

PHONE NUMBER:_______________________________

TRADE REFERENCES:

NAME:_________________________

ADDRESS:______________________

ADDRESS:______________________

PHONE#________________________

FAX # __________________________

NAME:_________________________

ADDRESS:______________________

ADDRESS:______________________

PHONE#________________________

FAX # __________________________

NAME:_________________________

ADDRESS:______________________

ADDRESS:______________________

PHONE#________________________

FAX # __________________________

 

I/We, the undersigned, (applicant) request the sale and delivery of products as stated above and further certify that the statements made on this application are true and correct.  Applicant here by authorizes the company to obtain credit information from any source. 

I/We agree that  (1) all invoices will be paid according to your stated terms. (2) In the event that there is a delinquency in payment, I/We will pay a late payment service charge, which is computed by a "periodic" rate of 1 1/2% per month, which is an ANNUAL PERCENTAGE RATE OF 18%. (3) In the event of default, I/We will pay all collection costs and an attorney's fee of one-third the amount due. (4) I/We will notify you immediately of any change in ownership or operations..

 

By signing this application, I/We authorize any institution to release credit information.  This information is to be held in strictest confidence and used solely for the purpose of obtaining  credit information.

 

______________________________________                __________________________________________

PRINTED NAME                                                 TITLE

 

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SIGNATURE                                                                        DATE