Credit Application/Agreement. Company Name: Check one: Corporation Partnership Sole Proprietorship Limited Liability Co.

Transcription

1 En-Net Services, LLC Phone: Fax: N East Street Frederick, MD Internet: administration@en-netservices.com Credit Application/Agreement Company Information: Company Name: Check one: Corporation Partnership Sole Proprietorship Limited Liability Co. /Partnership Limited Partnership: Name of General Partner Street Address: City: State: Zip: Telephone: Fax: Federal ID# - DUNS #: Type of Business: No. of Years in Business: State of Origin: Present Annual Sales Volume: $ Credit Limit Requested: $ Sales Tax Exempt # for Home State: (Please attach copy of form) Note: Other State forms may be required pending delivery location. Person to Contact Regarding Invoices: Phone: Accounts Payable address: Name of Predecessor Businesses: Parent Company: Street Address: City: State: Zip: Telephone: Fax: 712 N East Street, Frederick, MD (301) / Fax: (301) Initial Page 1 of 6 P

2 Information on Principals For Proprietorship or Partnership: List all Owners and/or Partners. For Corporation or Limited Liability Company: List all Officers, Directors, Members and Majority Stockholders. Name Home Address Phone Social Sec. No. Position Have any of the companies or individuals listed above ever been a debtor in a bankruptcy proceeding? Has any judgment ever been entered against any of the companies or individuals listed above? Are there legal actions or arbitrations pending against any of the companies or individuals listed above? ************************************************ The undersigned is either a sole proprietor, a partner in a partnership, an individual who may be executing a personal guarantee in connection with the extension of credit to Applicant, or one of the principal stockholders of a corporation. I give permission to En-Net Services to obtain and utilize an individual credit report on me personally to determine my creditworthiness. Social Sec. No. Dated Full name (printed) Signature ************************************************ Credit References: (Attached separate schedule if necessary) Primary Bank Name: Account# Phone: Fax: Other Bank: N East Street, Frederick, MD (301) / Fax: (301) Initial Page 2 of 6 P

3 Trade References: Please attach separate financial statement of assets and liabilities. TERMS AND CONDITIONS Payment terms are Net 30 from invoice date. Customer agrees to pay service charges of 1.5% interest per month on any invoice amount past due until paid, both before and after judgment, and further agrees to pay all cost incurred in collection of past due amounts, including attorney's fees in the event this account is placed with an attorney for collection, whether suit is filed thereon or not. Customer expressly agrees that the forum for any litigation pursuant to this Agreement or any other contract between Seller and Customer, whether suit is brought by Seller or Customer, shall be the County of Frederick, Maryland. This Agreement shall be governed by and construed in accordance with the laws of Maryland. Customer further agrees to pay all amounts due under this Agreement, including interest and cost of collection, for labor and materials supplied on this account before Seller has received written notice closing this account mailed U.S. Mail Certified Return Receipt Requested, no matter what person or entity ordered or used the labor and material supplied on this account and regardless of any change in the legal structure of the customer or the existence of entities or individuals legally distinct from Customer using or benefiting from the labor and material supplied. In the event of such a change in legal structure or the existence of related entities or individuals, it is agreed that both the Customer and the related legal entities or individuals shall be obligated for all amounts due under this Agreement. Seller may stop the manufacture or supply of any labor or materials when it, in its sole discretion, determines that Customer is in breach of this Agreement or any other contract with Seller, or Seller has insecurity with respect to Customer's creditworthiness, until payment is made and any dispute or insecurity has been resolved. Customer further agrees that Seller shall not, in any event, be responsible for any damage due to delay in supply of any labor or materials. I/we certify that the above information is correct and complete and further understand that Seller will rely on this information for the extension of credit. Customer authorizes Seller at any time and from time to time to obtain Credit Reports on Customer or any individuals listed above or to obtain credit and funding information from other persons or entities listed above. Customer further agrees to supply such additional information as may be required by Seller to warrant the future extensions of credit or to enable Seller to perfect liens or to recover upon any bond issued. 712 N East Street, Frederick, MD (301) / Fax: (301) Initial Page 3 of 6 P

4 Corporate Officer(s): Signed: Name (Print): Title: _ Date: _ _ CREDIT APPLICATION NOT ACCEPTED WITHOUT APPROVAL OF SELLER'S CREDIT DEPARTMENT The federal Equal Credit Opportunity Act prohibits creditors from discrimination against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Brian Sheffer, President, En-Net Services, 712 N East Street, Frederick, MD within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. ************************************************ En-Net Services Use Only: En-Net Sales rep to complete (please print): Customer Contact Name: Phone: N East Street, Frederick, MD (301) / Fax: (301) Initial Page 4 of 6 P

5 Authorization to Check Bank and Trade References CREDIT RELEASE En-Net Services, LLC is hereby authorized to request bank and trade reference information from the contacts I have provided on this credit application. Company Name Authorized Signature Printed Name Title Date 712 N East Street, Frederick, MD (301) / Fax: (301) Initial Page 5 of 6 P

6 PERSONAL GUARANTEE I/We, and, residing at (residential street address) and (City, State)(hereinafter Guarantors), do hereby personally guarantee the performance of credit extension/terms by and between En-Net Services LLC and. In the event that fails to make any payment to En-Net Services, or fails to perform in any manner with regard to said Agreement between the two entities, the Guarantors do hereby promise to make all payments to En-Net Services, LLC in the same manner as if they were the principals of said Agreement. And furthermore, the Guarantors do hereby authorize and empower any attorney of any court of record of the State of Maryland or elsewhere to appear for and to enter judgment against us, or any of us, in favor of En-Net Services, LLC for any sums due under the Agreement plus interest with costs of suit, release of errors, without stay of execution, and with one-third of balance due as a reasonable attorney's fee, and the Guarantors hereby waive and release all benefit and relief from any and all appraisement, stay or exemption laws of any state now in force or hereafter to be passed. IN WITNESS WHEREOF, this personal guarantee is entered into this day of (month & day), (year), in the STATE OF, COUNTY OF. Signature of Guarantor Signature of Guarantor STATE OF COUNTY OF Date Date (Place seal here) Notary Public My commission expires, 712 N East Street, Frederick, MD (301) / Fax: (301) Initial Page 6 of 6 P