Credit Application Handbook Version 1.02

THE CREDIT
APPLICATION
HANDBOOK
PREPARED BY:
85%
85% SUCCESS RATE ON LARGE VIABLE CLAIMS

CONTINGENCY RATES: 10% TO 25%
© The Kaplan Group 2014

version 1.02
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2 THE CREDIT APPLICATION HANDBOOK
In this ebook, we explain the purpose of the credit application and provide
specific language regarding the three main uses for a credit application:
Collect information to Establish terms Get protections

evaluate potential with your in the event of
customer’s credit customer default
We have included over 20 sample credit applications. You can download

Microsoft Word versions of these forms for free if you want to modify one
for your company’s use.
CLICK HERE TO DOWNLOAD MS WORD VERSIONS !
If you find this ebook helpful, please share with others, and express your
appreciation through the social media links below.
DISCLAIMER: We are not attorneys and we are not giving legal advice. We encourage you to have your
attorney review your credit application and discuss the key issues facing your specific business. This ebook
is presented to share information only. We make no representation regarding the accuracy or
completeness. You agree to not hold The Kaplan Group or its owners, officers, directors or employees
liable in any way based on your use of the information provided in this ebook.
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CREDIT APPLICATION ESSENTIALS
BACKGROUND CONTRACTUAL
INFORMATION TERMS
Information is True
Who is the customer
Binding & Authorized
Extensive Contact Information
Customer Owes Vendor
How Much Credit
Right to Investigate
Trade & Bank References
Vendor Controls Terms & Decisions
DEFAULT OTHER
PROVISIONS TERMS
Personal Guaranty Provide Financial Statements

Interest & Acceleration Solvency Declaration
Collection & Attorney Costs Allocation of Payments
Litigation Home Field Advantage Security Interests
PROPERLY
EXECUTED
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TABLE OF CONTENTS
1. Overview: Why do Credit Applications Exist and General Considerations ......... 5
2. Information required to evaluate credit .............................................................. 8
3. Terms of granting credit ..................................................................................... 14
4. Terms to protect creditor if customer defaults ................................................. 20
5. Other terms governing your commercial relationship with your customer ...... 30
6. How the application should be executed (e.g. signatures and titles) ............... 34
7. Checklist to evaluate your current or proposed credit application ................... 36
8. Our 2 Favorite Credit Application Templates .................................................... 40
9. Over 17 sample credit applications .................................................................... 44
You can download for free a Microsoft Word version of each sample credit
application so you can customize for your company.
CLICK HERE TO DOWNLOAD MS WORD VERSIONS !
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SECTION 1:
WHY DO CREDIT
APPLICATIONS EXIST
AND GENERAL
CONSIDERATIONS
?
OVERVIEW
From the beginning of commerce, not all customers have had the money to pay for goods or
services at the time they were acquired. With respect to businesses selling to other businesses, it
is common practice in many industries to allow customers to pay at later date. Instead of
customers borrowing money from a bank to pay at the time of purchase, they borrow from their
vendors.
Banks do not loan money without first evaluating the potential customers’ credit to determine the
likelihood of getting repaid. Vendors should do the same. Like banks, vendors need to collect
information from the potential customer (Applicant), evaluate the information provided to
determine what level of credit to grant, and then grant certain amounts of credit based on agreed
upon terms of repayment.
The credit application (Application) is the

initial document used by Vendors to collect
information and establish contractual terms
with the Applicant. Some vendor/customer
relationships should have lengthy contracts
describing the relationship due to the
volume of business and critical terms for
either party. The Application is not the place
for a lengthy contract. A short Application
can be sufficient when a secondary contract
is going to be executed prior to the commencement of sales and purchases.
But, in many cases, the Application is going to be the only document between customer and
vendor signed by the customer. This is the unique opportunity for the vendor to establish critical
terms (and protections) in their relationship with customers. At this moment, vendors have
something customers want: product or services to be provided now and paid for at a later time.
This is the time when customers typically will agree to industry

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customers will be less likely to agree to any new conditions.

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Fortunately, customers understand this, and these key terms can easily be built in to an
Application. A balancing act is required. Customers will be turned off by longer forms and
contracts and may turn to other potential vendors. So, vendors need to find the sweet spot that
works best for them with respect to the length of the Application and the terms incorporated
therein. Typically, credit applications are one page long if only collecting information and two
pages if also adding terms of granting credit. Occasionally they are longer, but in general two
pages should be sufficient to get the necessary information AND the necessary terms to protect
your company.
Throughout this ebook, we provide particular focus on information and terms you can request that
will give you an advantage if the customer’s account becomes delinquent. With over 20 years of
debt collection experience, we know what terms give you, us, and if necessary, an attorney, a
distinct advantage in getting customers to pay your invoices, even during tough times. Just a few
words here and there in a credit application can save you thousands, tens of thousands, or more
each year!
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Next: Information Required To Evaluate Credit

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SECTION 2:
INFORMATION
REQUIRED TO
EVALUATE CREDIT
i
2A. BASIC IDENTIFICATION INFORMATION

In order to evaluate a company's credit, you need some basic information:
Who they are (name); Who is the owner;

What they are Where they are
(type of entity); located;
The amount and

References.
How they will order type of credit they
How to contact
from you; are seeking;
them;
In deciding what information to request, we recommend

that you include what you need now to make the credit
decision AND what you might need if they ever become
delinquent. The more names, phone numbers, email
addresses, home addresses, and identification numbers
(social security, Dun & Bradstreet, State and Federal ID,
resale permits, contractor’s license, etc.) you have, the
better your internal staff and external collection agency
can pursue delinquent balances. Be sure to get more
than just the accounts payable person’s name and
contact information. You want information on the owner
if it is a small business, and senior management or
executive level information for medium size businesses
(e.g. $10 million to $100 million in revenue). The form on
the following page shows the type of information that is
helpful to collect.
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SAMPLE FORM: BASIC IDENTIFICATION INFORMATION
Legal Business Name ___________________ Trade Name – DBA _________________________

Phone # _____________________________ Fax # ____________________________________
Billing Address ________________________ City, State, Zip ____________________________
Shipping Address ______________________ City, State, Zip ____________________________
Business is a: □ Corporation □ LLC □Partnership □ Proprietorship Year Started _______
State of Org. ______ Federal I.D. # ______________ Dun & Bradstreet # _____________
State ID # __________ Reseller Permit # ____________Website Address: _________________________
_______________________________________________________________________________________
Are you a: Subsidiary □ Division □ Parent Company Name: ____________________________

Address __________________________________________________________________
City ___________________________________ State __________ Zip Code _________
Do you require a purchase order # before we accept an order? □ Yes □ No
A/P contact Name ____________________ Phone # ____________________________
E-mail Address _____________________________________________________________
Estimated Monthly Purchases $_________________________________________________
Terms Requested □ COD Company Check □ Credit Card □ Net Terms – Credit Requested $ _______
_______________________________________________________________________________________
Check One □ Principal/Owner □ Partner □ Proprietor

Name ____________________________________ Social Security # __________________
Address ___________________________________________________________
Home Phone ____________________ Mobile Phone __________________
E-mail Address _____________________________ Driver’s License # _____________
Have you ever filed for bankruptcy? □ Yes □No If yes, please attach explanation.
Information should be supplied for each Principal or Partner on separate attached sheets.
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2B. TRADE AND BANK REFERENCES

After obtaining the basic identification information, it is important to get information to evaluate the
credit of the Applicant. Most companies want banking information and trade references who can
be contacted to get historical information.
Trade References (Major Suppliers)
1. Name ______________ Contact ______________ Phone Number ________________

Credit Term _________ Credit Limit ___________ Fax Number __________________
2. Name ______________ Contact ______________ Phone Number _______________
Credit Term _________ Credit Limit ___________ Fax Number _________________
3. Name ______________ Contact ______________ Phone Number _______________
Credit Term _________ Credit Limit ___________ Fax Number _________________
Bank References
Name ____________________ Contact Name ______________ Phone # ______________

Address ________________ City, State, Zip _______________ Date Opened ___________
Checking # ________________ Savings # _________________ Loan # ________________
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2C. LESS COMMONLY REQUESTED INFO

The following items are frequently included on some (e.g. less than 50%) credit applications:
2 Former business address
2 List of all owners (name, title, and social security number)
2 Estimated annual sales
2 Type of business (manufacturing, distributor, wholesale, retail, service, internet only, other)
2 Mortgage holder or landlord (name, phone, address)
2 Any outstanding liens or judgments
2 Any current or threatened litigation
2 Any NSF checks in last six months
If you have a specific reason for requesting any

or all of this information then you should
include it in the Application. The only reason
ask for all of it is related to the goal of keeping
the application to your target size of one or two
pages.
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2D. SIGNATURE BLOCK
For companies that use the Application solely for obtaining information in order to evaluate credit,
the signature block only needs to indicate that the information is accurate and can be used by
Vendor to evaluate credit:
We certify that the above information is true and correct and we agree to pay this
account in accordance with your credit terms. We authorize you to verify this information
and to obtain any reports containing credit or personal information that is required in
obtain credit from Vendor.
For a template of this simple Application, click here to go to page __ in this document. BUT, unless
you plan to have your customer sign another agreement prior to making sales, we strongly
encourage you to include many (if not all) of the items discussed in the next two sections: Terms of
Granting Credit and Default Provisions.
Next: Terms of Granting Credit
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SECTION 3:
TERMS OF
GRANTING CREDIT
3
CONTRACTUAL TERMS
What are the contractual terms between you and your customer if you do not have a written
agreement?
If there is no written documentation, could your customer say that there was a verbal agreement
with the sales person that they could return them in 6 months? Or, that they pay you when they get
paid by their customer? Or, they don’t have to pay for months of services if they were not 100%
satisfied?
We pose these questions as a way of highlighting the importance of having agreed upon terms.
The Uniform Commercial Code (UCC) is the primary source of laws governing commercial
transactions in the USA. But, the laws allow verbal agreements and your customer’s forms (for
example, terms on a purchase order) to dictate the terms of a transaction in the absence of any
other agreement. In this section, we review the following key terms that should be part of any
agreement to grant credit to a customer:
A. Binding Agreement
B. Authorized to bind company
C. Information is true
D. Vendor can evaluate Applicant’s credit
E. Vendor’s discretion to grant credit
F. Applicant owes Vendor
G. Vendor’s forms have precedence
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3A. BINDING AGREEMENT

The first item is to establish that your Application is the binding, legal document that governs all
transactions. You don’t want your customer to come back and say “Oh, I thought I was just
providing information. It was not clear to me that this was a contract”. Sample language:
The undersigned (“Applicant”) hereby applies for credit with Vendor with this Credit
Application (“Application”), and in making this Application the Applicant agrees to be
bound by all of the terms and conditions contained in this Application (optional: and
terms and conditions of Vendor’s invoice and posted on Vendor’s website; or name any
other document with relevant terms and conditions).
Including the reference to terms posted on your website can be extremely helpful. When you
need to change terms, it is much easier to change your website than any other method.
3B. AUTHORIZED TO EXECUTE

While the legal principal of Apparent Authority should protect you, it is better to have a statement
where the signer indicates they are authorized to bind the Applicant to the agreement:
You represent that Applicant is a valid business entity and that you
are an authorized representative of Applicant with authority to
enter into contractual agreements.
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3C. INFORMATION IS TRUE

If the Applicant lies to you on the Application and you don’t catch it during your evaluation
process, then if something goes wrong, there is not much chance of having a good final outcome.
However, an individual can be held personally liable when they commit fraud, and fraud
obligations are not dischargeable in bankruptcy. It is typically very difficult to collect from
someone who intentionally commits fraud, but the following language can help, and it puts people
on notice to not file false or misleading information.
The persons signing this application certify that all of the information contained in this
application and any attachment or amendment is true, correct and complete to the best
of their information, knowledge and belief.
3D. RIGHT TO INVESTIGATE

As discussed in section 2D, you want to specifically get permission to investigate the information
provided by the Applicant for both extending credit and collecting open invoices. By law, you
cannot run a credit report on an individual without their written permission. The information on
the business owner’s credit report can help you with your credit evaluation process of the
Applicant. Just as important, it can be very valuable if the account becomes delinquent. If the
credit report shows the business owner is in very bad or very good personal financial shape, this
will influence the collection process on delinquent accounts. It will be very difficult to get
permission to run the report once there is a payment problem, but typically very easy at the
Application stage.
You consent to Vendor obtaining information about you personally and the Applicant
from credit reporting agencies and other sources Vendor deems appropriate in
considering this Application and for purposes of updates, renewals or extensions of
credit granted or in reviewing or collecting Applicant’s account.
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3E. VENDOR'S SOLE DISCRETION

Applicant to be able to claim now, or in the future, that they have any right to credit from your
company:
As a result of this Application or otherwise, should a credit availability be granted by

Vendor to the Applicant, all decisions with respect to the extension or continuation of
credit shall be in the sole discretion of the Vendor.
3F. APPLICANT OWES VENDOR

You want it clear that the Buyer owes you for any goods or services purchased:
With respect to any sales of goods or services by Vendor to the Applicant on credit, the
Applicant agrees that all amounts payable on or before the net due date as shown on
each of the Vendor’s invoices will be paid by the said due date, and, if not paid on or
before said due date, will then be deemed to be delinquent (a “Delinquency”). If no due
date is listed on an invoice, terms for that sale will be net 30 days.
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3G. BATTLE OF THE FORMS

Finally, you want to establish that the terms of the Application supersede any terms the Applicant
may have on their purchase orders or other documents. Here are a couple different ways to
document this:
No terms or conditions of purchase orders which are different from the terms of the
Vendor as contained in this Application or any other terms of sale of Buyer will become
part of any sales agreement or other document unless specifically approved in writing by
the Vendor.
Or
Applicant’s orders shall be deemed to incorporate the terms and conditions of this
Application and on Vendor’s invoices. In no event shall preprinted terms and conditions
on Applicant’s documents, such as purchase orders, confirmations, acceptances, etc.
modify or add to Vendor’s terms or this Application.
This language is extremely important. Otherwise, your customer could argue that their purchase or
verbal order that said Net 180 days supersedes the Net 30 on your invoice. Or that your salesman
said they could pay after their customer paid them. Or they could cancel a 12 month contract with
1 day notice.
In addition to these basic terms for granting credit, we strongly recommend that you include terms
that apply if your customer does not pay on time. These terms can significantly increase the
likelihood of getting paid and the amount you get paid, as described in the next section.
Next: Terms To Protect Creditor If Customer Defaults
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SECTION 4:
TERMS TO PROTECT
CREDITOR IF CUSTOMER
DEFAULTS
DEFAULT PROVISIONS
Default Provisions can have a big impact on your eventual ability to collect when a customer does
not pay on time. These provisions can give the Vendor significantly more leverage when dealing
with delinquent accounts. This leverage may be enough to make your invoices go to the top of
the debtor’s pay list, whether collecting in house, when turned over to a collection agency, or if
litigation becomes necessary. As a collection agency specializing in large B2B claims, we know
that the better these terms are covered correctly in the paperwork, the higher our success rate
and the faster we collect more money. In this section, we cover the following items:
A. Personal Guaranty
B. Interest and Acceleration
C. Collection Costs and Attorney Fees
D. Litigate or Arbitrate
E. Home Field Advantage Option
F. Jury Waiver
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4A. PERSONAL GUARANTY

While the majority of potential customers may not agree to provide a personal guaranty, it doesn’t
hurt to ask. Many individuals will agree simply because it is in your Application. Individuals can
always cross it out or not sign it if they refuse to guaranty the Applicant’s purchases. A personal
guaranty does not guaranty that you will get paid, but it does have many advantages: 1) it does
provide a secondary source of repayment, 2) If the company does go out of business, you can still
try to collect from the personal guarantor, and 3) obligations with a personal guaranty have
priority over corporate-only obligations in the eyes of the personal guarantor. We’ve seen many
situations where a business owner determines the company is likely to fail, and they spend the
last several months of the business’s existence getting non-guaranteed credit and using the
ultimate proceeds to pay down obligations that are personally guaranteed.
Some guarantees can be multiple pages long, others simply a paragraph, and others simply part
of a sentence. Who needs to sign is different in community property states. How a guaranty is
signed is very important. The more money at stake, the more thorough the personal guaranty
should be. We have a free ebook dedicated to thus subject available on our website to discuss
this in further detail. Below are two of the simpler examples:
For and in consideration of the allowance to Applicant of an open account, I/we, the
undersigned Guarantor(s), hereby personally guarantee, unconditionally and at all times, to
Vendor, the payment of all obligations, indebtedness, and liability which may be now or
hereafter owing by Applicant to Vendor, including, but not limited to, all monthly service
charges, attorney’s fees, costs, and interest.
Or
I/we, the undersigned guarantor(s), understand that this agreement of personal guarantee as
provided herein shall be a continuing obligation and may not be revoked except by written
agreement expressly canceling this personal guarantee signed by the Vendor.
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In other situations, we have seen this simple sentence (which is not 100% definitive) in the
signature block of the Application result in recovery primarily because of the personal guaranty
provision.
NOTWITHSTANDING THAT THIS ACCOUNT IS ESTABLISHED IN THE NAME OF A

BUSINESS, I PERSONALLY GUARANTEE PAYMENT OF THE ACCOUNT (MUST BE AN
OFFICER TO SIGN ON BEHALF OF THE COMPANY)
CLICK HERE TO
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PERSONAL GUARANTY
HANDBOOK!
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4B. INTEREST AND ACCELERATION

It is important to indicate that interest is due at a certain rate (not to exceed the maximum allowed
so you don’t violate usury laws) from the past due date. Without this clause, interest may not start
to accrue until the date you sue and get a judgment, and it will be at the much lower statutory rate
determined by state law that has jurisdiction. On a 2 year old invoice of $10,000, the accrued
interest at 18% of $3,600 provides significant leverage to negotiate a resolution to avoid court.
And if you have to go to court, you may eventually collect all of this interest which will offset your
collection and attorney costs.
Should Applicant default on any payment(s), Vendor reserves the right to declare all
invoice amounts due and payable without notice to Applicant and shall have the right to
charge a finance fee of 1.5% (or the highest rate allowed by law, if less) per month, for
any invoice that is past due.
Note that this sentence has an acceleration clause, where once one invoice is past due, all
invoices become due immediately. If things go wrong and you have to send this to collections or
litigate, you want to be able to pursue the full amount you are owed, even amounts that would not
currently be owed if there was no delinquency.
For service providers who enter into long-term contracts with payments over time, the following
acceleration language can be used:
Should Applicant default on any payment(s), Vendor reserves the right to declare all
remaining payments for the balance of the term of the contact immediately due and
payable without notice to Applicant.
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4C. COLLECTION COST AND ATTORNEY FESS

In the USA, typically, you will not have the legal right to recover collection costs or attorney fees
unless there is a signed written agreement with this provision. Just having this provision on your
invoices is not necessarily enough. You want to have a document signed by your customer
indicating they agree to this provision and the Application is typically the best document to
memorialize this term. You want to specifically include collection costs so that collection agencies
can add this fee into the amount they are trying to recover on a pre-litigation basis, as they cannot
add “potential” attorney fees at this stage. Whether or not you actually collect these costs, it gives
you and your agents much more leverage during collection agency, litigation, and judgment
collection activities.
In the event that Vendor commences any action to collect delinquent invoices, Applicant
agrees to pay collection expenses and attorney fees, whether or not suit is filed.
We see the following version less frequently, but it has the advantage of spelling out the liquidated
damages in the event of default. Some courts use a schedule to determine the fee to be awarded
to attorneys for getting a judgment. This fee typically is substantially less than the contingency or
hourly fee paid to the attorney. By having an agreed attorney cost in the executed Application, the
Vendor has a much better chance of being awarded the full attorney cost, thereby offsetting the
cost of having to litigate to get paid. It also helps at the collection agency stage, and gives in
house collectors more leverage during the threat to send to collections:
We further agree to pay a 25% collection charge, in the event of default, if the account is
placed with an attorney or bonded collection agency.
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4D. LITIGATION OR ARBITRATION

Many people believe that arbitration is better that going to court, and this may be true in a number
of situations. But, in our opinion, for the vast majority of debt collection matters, we believe that
litigation is the better approach. In most cases, the out of pocket costs for arbitration are higher
than the filing fees associated with going to court, primarily because you have to pay the arbitrator
for their time. Further, you don’t have the ability to do discovery to the same extent as you have in
court proceedings, and this can be very important if your customer is disputing the balance,
especially with completely fabricated disputes. Many courts allow you to request pre-judgment
attachments, putting additional pressure on Applicants much faster, but this is not allowed in
arbitration. Finally, when you have attorneys willing to do the collection effort on a contingency
fee basis (our collection agency has a network of attorneys across the country who work on
contingency for collection matters), there usually is no difference in the attorney fees. One of the
main arguments in favor of arbitration is potentially lower attorney costs, but that does not apply
to the vast majority of collection matters we have encountered. Most of the credit applications we
have seen call for litigation and not arbitration.
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4E. HOME FIELD ADVANTAGE OPTION

If you do have to sue, most likely you will have to sue where your customer is located unless you
have a clause stating otherwise. While we have a nationwide attorney network to provide this
coverage, in the remote possibility that there is a trial, you may have to send a witness to the
courtroom where your customer is located. No one wants to incur this added cost and
inconvenience.
Alternatively, if you can sue where you are located, this makes it more difficult and expensive for
your customer to defend if they are located far away. This provision can be very important if there
is a dispute, and it also gives you greater leverage in collections at the pre-litigation stage. Suing
in your local courthouse makes it more likely you will get a default judgment rather than the riskier
and lengthier process of a trial where the Applicant is located. As a collection agency, we can get
higher pre-litigation settlements in cases where the Applicant realizes we can sue in our client’s
home court and they won’t travel or hire an out of state attorney to defend the lawsuit.
The language regarding location of litigation must be very precise. In one well known case, a
clause that stated that “the courts of California, Orange County shall have jurisdiction over the
parties…” was held to not require litigation in Orange County. The word “jurisdiction” was
considered “permissive”, not “mandatory”. To avoid this problem, the we recommend that the
clause include venue, jurisdiction and state law references for the Vendor’s home court, and not
include any permissive modifiers:
The parties expressly agree that any and all disputes of whatever character arising under this
agreement or under any statute or common law relating, directly or indirectly, to the subject
matter of this agreement or the dealings of the parties relating thereto, shall be litigated only in
the ______ court of _______ County, State of ___________, or in the federal district court having
jurisdiction for such county, and Applicant hereby consents to the jurisdiction of said courts and
that said disputes shall be governed by the laws of said state.
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However, if your customer’s assets are out of state and you have to do court ordered judgment
collection activities, there will be increased costs associated with transferring the matter to a
collection attorney located in the venue of the debtor’s assets. In cases where disputes are
unlikely, it is less expensive and faster to sue where your customer is located. The best approach
is to have the Applicant agree that the Vendor gets to choose where litigation can be initiated:
The parties expressly agree that any and all disputes of whatever character arising
under this agreement or under any statute or common law relating, directly or indirectly,
to the subject matter of this agreement or the dealings of the parties relating thereto,
shall be litigated, at the Creditor’s sole discretion, either in the ______ court of _______
County, State of ___________, or in the federal district court having jurisdiction for such
county, or, alternatively, in the state or the federal district court having jurisdiction for the
county in which Applicant’s business is located at the time of filing of suit. Applicant
hereby consents to the jurisdiction of said courts and that said disputes shall be
governed by the laws of said respective states.
The extra 33 words in this paragraph could be worth thousands to tens of thousands in lower legal
costs and higher pre-litigation recoveries each year.
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4F. JURY WAIVER

In our experience, trials are very rare in collection litigation, and jury trials even rarer. But, if there
are significant amounts involved, and potential disputes, you may prefer that a judge rather than a
jury would decide your fate.
THE PARTIES HERETO KNOWINGLY AND INTENTIONALLY WAIVE THE RIGHT TO A JURY
TRIAL ON ANY ISSUE OR DISPUTE THAT MAY ARISE BETWEEN THEM.
Or
Trial by jury is waived.
Next: Other Terms Governing Your Commercial Relationship
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SECTION 5:
OTHER TERMS GOVERNING YOUR
COMMERCIAL RELATIONSHIP
3
OPTIONAL TERMS
Most companies have extensive terms and conditions separate from the Application so that the
Application can remain only 1 or 2 pages long. These include issues such as returns, restocking
fees, warranty, protecting intellectual property, statement of when risk of loss transfers, and
reseller permit information. We cover these times in a separate ebook.
With respect to evaluating and granting credit, there are a few more items that are less common
but can be very helpful.
A. Financial Statements
B. Solvency Declaration
C. Allocation of Payments
D. Security Interest
CLICK HERE TO
DOWNLOAD OUR FREE
TERMS & CONDITIONS
HANDBOOK!
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5A. FINANCIAL STATEMENTS

It is not easy to get financial statements from privately held companies. Most refuse. But, if the
following language is in your Application, it will increase your likelihood of getting this information,
which can be very helpful during the credit evaluation process and if they become delinquent.
Applicants can always cross it out if they refuse to agree.
As a condition of the continued extension of credit by the Vendor, the Applicant agrees,
at the Vendor’s request, to provide to the Vendor updated financial information, and if
requested, to timely provide an annual or other periodic financial statement to Vendor.
The applicant further agrees to provide the Vendor with an updated credit application on
request as a condition for the continued extension of credit.
CLICK HERE TO
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FINANCIAL STATEMENT
ANALYSIS EBOOK!
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5B. SOLVENCY DECLARATION

In the absence of financial statements, and alternative approach is to ask the Applicant to simply
state that they are solvent. A company can be considered insolvent due to lack of liquidity to pay
debts or when liabilities exceed net assets. A company may have a good credit history, but recent
events (a major customer files bankruptcy while owing the Applicant a substantial amount) may
render the Applicant insolvent. A solvency representation can expose this risk and potentially
create personal liability in the event of misrepresentation.
The Applicant agrees that the continued solvency of the Applicant is a precondition to
any extension of credit made by the Vendor to the Applicant. On request, the Applicant
agrees to provide Vendor a statement representing that the Applicant is and remains
solvent.
5C. ALLOCATION OF PAYMENTS

Bankruptcy law states that preferential payments made to vendors during the 90 days prior to a
bankruptcy filing must be returned. If your customer files bankruptcy, your chances of getting paid
on open invoices are very low. But, it is even worse when you have to return money received in
the last 90 days. There are guidelines to determine if payments were preferential and need to be
returned. The following language may help you retain some or all of what you received during
that 90 day period.
All payments may be applied against open charges in the sole discretion of the Vendor.
Or
In the event that from time to time the Vendor may owe credits, refunds, reserves or
other monies to the Applicant, such indebtedness shall be deemed to be created from
this Agreement, and the Vendor shall have the right of recoupment of such credits or
refunds within its sole discretion.
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5D. SECURITY INTEREST

If the Vendor has a valid security interest in the products sold to Applicant which are still in
Applicant’s possession, the Vendor can repossess the product in the event of default. Typically,
security agreements are separate, multi-page documents and the Vendor should file a UCC-1 to
perfect the security interest, as explained in our Security Agreement ebook. The following simple
statement may help if the Applicant does not pay on time and still has your merchandise.
Customer hereby grants Vendor a perfected security interest in any and all goods
purchased by Applicant from Vendor (and all proceeds thereof) to secure any and all
obligations of Applicant to Vendor
Next: How The Application Should Be Executed
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SECTION 6:
HOW THE APPLICATION
SHOULD BE EXECUTED
SIGNATURE BLOCK
An improperly designed signature block or executed application can eviscerate many of the
creditor protections built in to an otherwise well designed application. The right to run a personal
credit report and the personal guaranty are tied to the signature. A personal guaranty can be
voided if the signature includes the person’s corporate title. Community property is excluded if
the spouse does not sign the personal guaranty.
If the above considerations are not important to the Vendor, given the legal principal of Apparent
Authority, almost anyone can sign the credit application on behalf of the Applicant. As long as it
seems reasonable to believe that the individual has authority to bind the Applicant, it is likely to be
binding. We regularly see applications signed by office managers, accounts payable clerks,
purchasing department members, and other employees who are the ones seeking the specific
products or services for their department. But, it is not reasonable to assume that a part-time
receptionist, delivery driver, or member of the cleaning crew has authority to bind the company.
You can mitigate risk by insisting that the Application be signed by an owner, officer, or manager
of some level.
The signature block is typically located at the end of the Application, and is immediately preceded
by the terms and conditions you decide to include in the Application. The standard signature
block is simply the Name, Title, Signature and date.
Name______________ Title ________________ Signature ___________________ Date ____

If you are obtaining a personal guaranty, it is best to have a separate signature block that
immediately follows the guaranty language. This makes it very clear that the guarantor realizes
they are providing a secondary agreement in the Application.
Name (No Title) ____________________________ Signature ________________________
Social Security # ____________________________ Date ____________________________
For community property states only, add a section for spouse:
If you live in the following states, your spouse must also sign the personal guaranty:
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c 805-541-2639
SECTION 7:
CHECKLIST
Use the checklist below to evaluate your current credit application to determine which items are
not adequately covered. Then go to the section of this ebook that discusses these items for an
explanation and sample language. You can also review the 19 sample credit applications provided
in Sections 8 and 9 of this ebook for other examples of how each of these items is handled by
other companies.
Basic Information:
ü Who they are (name)

ü What they are (type of entity);
ü Who is the owner (name, personal contact info);
ü Where they are located (addresses);
ü How to contact them (phone, fax, email, mobile phone);
ü How they will order from you (purchase order, verbal, etc.);
ü The amount and type of credit they are seeking (COD, Credit Card, Terms)
ü Trade references;
ü Bank reference.
Optional Additional Information
ü Shipping address;
ü Former addresses;
ü List of all owners (name, title, social security #);
ü Estimated annual sales;
ü Type of business (manufacturer, wholesale, retail, internet retail, other);
ü Mortgage holder or landlord contact information;
ü Outstanding liens or judgments;
ü Current or threatened litigation;
ü Any NSF checks in last 6 months.
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Basic Agreement Terms
ü Explicitly states it is a binding agreement ;

ü Person signing is authorized to bind company;
ü The information is true;
ü Vendor can evaluate Applicant’s credit;
ü Vendor can evaluate owner's credit;
ü Vendor’s discretion to grant credit;
ü Applicant owes Vendor for purchases;
ü Vendors forms have precedence;
Default Provisions
ü Personal guaranty;
ü Interest and acceleration;
ü Collection costs and attorney fees;
ü Litigate or Arbitrate;
ü Vendors choice for venue, jurisdiction, and law;
ü Jury waiver.
Optional Credit Provisions
ü Agree to provide financial statements

ü Solvency Declaration
ü Allocation of Payments
ü Security Interests
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Signature Block
ü Printed Name, Title, Date

ü Separate for Personal Guaranty
o No Title specified
o Spouse for community property states.
Next: Favorite Templates
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SECTION 8:
FAVORITE 1 PAGE AND
2 PAGE TEMPLATES
CLICK HERE TO
DOWNLOAD MS
WORD VERSIONS !
CA401 Click here to download MS Word version of this template!
Company Name Fax Application To:

Or Email To:
CREDIT APPLICATION
Legal Business Name Trade Name-DBA Phone # _________________

Fax #
Billing Address City State Zip Code
Shipping Address City State Zip Code
Business Is a: Corporation LLC Partnership Proprietorship

Year Started_____________ State of Inc. _________Federal I.D.#:__________________________________
Web Site Address:_________________________________ Dun & Bradstreet #________________________
Are You a: Subsidiary Division (if yes, check which)

Parent Company Name:________________________________ Address _______________________________
City:__________________________________________ State:_______________________ Zip:____________
Do you require a purchase order# before we accept an order? Yes No
A/P Contact _____________________________A/P Email____________________________
A/P Phone__________________ Estimated Monthly Purchases. $ _____________
Terms Requested: COD Credit Card Net terms – Credit Limit Requested $_________________
Check one: Principal Partner Proprietor
Name:____________________________________________________ Social Security#__________________
Home Address:_________________________________ City:___________________ State: ___ Zip:________
Home Phone:_______________________ Mobile #______________________Email_____________________
Bank References
Name Contact Name Phone No
Street Address City, State, zip Code Date Opened
Type of Account Checking No________________ Saving No_______________ Loan No_____________

Trade References (Major Supplies)
1. Name Contact Name Phone No.
Street Address City, State, Zip Code Account No.
Street address City, State, Zip Code Account No.
You represent you are an authorized representative with authority to enter into this agreement and the information contained in this
Application and any attachment is true, correct and complete. You consent to Vendor obtaining information about you personally and
the Applicant from credit reporting agencies and other sources Vendor deems appropriate in considering this Application. If credit is
extended, you agree to be bound by all of the terms and conditions on Vendor’s invoices and posted on Vendor’s website.
________________________________ _____________ _____________________

Signature Date Title
CA402, page 1 Click here to download MS Word version of this template!
Company Name Fax Application To:

Or Email To:
CREDIT APPLICATION Mail Original To:
Legal Business Name Trade Name-DBA Phone # _________________

Fax #

Year Started___________________________________ State of Inc. __________________________________
Federal I.D.#:__________________________________ Dun & Bradstreet#_____________________________
Web Site Address:______________________________ License Type & #_____________________________

Parent Company Name:______________________________________________________________________
Address:__________________________________________________________________________________
City:__________________________________________ State:_______________________ Zip:____________
Do you require a purchase order# before we accept an order? Yes No
A/P Contact _________________________Email_________________________Phone__________________
Est Monthly Purchases. $ _____________ Any Liens or Judgments? Yes No
Have you ever filed for bankruptcy? Yes No If yes, please attach explanation
Terms Requested: COD Company Check Credit Card (Visa, Master Card, American Express only)
COD Post Dated Check Net terms – Credit Limit Requested $_________________
BANK AND TRADE REFERENCES MUST BE COMPLETED TO BE CONSIDERED FOR NET TERMS
**PLEASE INCLUDE CURRENT YEAR FINANCIAL STATEMENT WITH NET TERMS REQUESTS**
Financial statement must include a balance sheet and income statement.
Unaudited statement must be signed by the company’s owner/officer. The statement time period must be indicated.
Name:____________________________________________________ Social Security#__________________
Home Address:_____________________________________________________________________________
City:____________________________________ State: __________________________ Zip:______________
Home Phone:_______________________Mobile #______________________Email_____________________
Bank References

CA402, page 2
Street address City, State, Zip Code Account No.
The undersigned (“Applicant”) hereby applies for trade credit with Vendor (“Vendor”) with this Credit Application
(“Application”), and agrees to be bound by all of the terms and conditions contained in this Application, on Vendor’s invoices, and
posted on Vendor’s website. In no event shall terms and conditions on Applicant’s documents, such as purchase orders,
confirmations, acceptances, etc. modify or add to Vendor’s terms.!Applicant agrees to make payment in full to Vendor for all amounts
due on or before net due date. Should Applicant default on any payment(s), Vendor reserves the right to declare all invoice amounts
due and payable without notice to Applicant and shall have the right to charge a finance fee of 1.5% (or the highest rate allowed by
law, if less) per month, for any invoice that is past due. In the event of default, Applicant will pay 25% of the due amount to cover
collection costs or attorney fees if the account is placed with a collection agency or attorney, whether or not suit is filed.
You consent to Vendor obtaining information about you personally and the Applicant from credit reporting agencies and
other sources Vendor deems appropriate in considering this Application and for purposes of updates, renewals, or extensions of credit
granted or in reviewing or collecting Applicant’s account. You represent that Applicant is a valid business entity, that you are an
authorized representative of Applicant with authority to enter into these contractual agreements, and the information contained in this
Application and any attachment is true, correct and complete to the best of your information, knowledge and belief.
The parties expressly agree that any and all disputes of whatever character arising under this agreement or under any
statute or common law relating, directly or indirectly, to the subject matter of this agreement or the dealings of the parties
relating thereto, shall be litigated, at the Vendor’s sole discretion, either in the ______ court of _______ County, State of
___________, or in the federal district court having jurisdiction for such county, or, alternatively, in the state or the federal
district court having jurisdiction for the county in which Applicant’s business is located at the time of filing of suit.
Applicant hereby consents to the jurisdiction of said courts and that said disputes shall be governed by the laws of said
respective states. Jury by trial is waived. All decisions with respect to the extension or continuation of credit shall be in the
sole discretion of the Vendor.
Authorized Individual (Print Name) Signature Title Date
INDIVIDUAL PERSONAL GUARANTEE
I, _________________________________for good and valuable consideration, including the extension of

credit which I hereby acknowledge as having been received do hereby personally guarantee and promise to pay
any obligation to Vendor on demand for any indebtedness of Applicant to Vendor which may become due. This
guarantee shall be a continuing and irrevocable guarantee and indemnity to Vendor.
I do hereby waive notice of default, non- payment and notice thereof and to Jury trial and consent to all
renewals and modifications of extension of credit.
Date ________________________________ Signature _______________________________________
Social Security Number____________________________

SECTION 9:
17 REAL APPLICATIONS
CLICK HERE TO
DOWNLOAD MS
WORD VERSIONS !
OUR FAVORITE 17 MORE CREDIT APPLICATION
APPLICATIONS SAMPLES
CA401 Simple Applications – Information Collection Only
CA402
CA101
CA102
CA103
CA104
CA105
Alternative 1 Page Information Only Applications

CA201
CA202
CA203
CA204
CA205
Multiple Page Applications with Contractual Terms

CA301
CA302
CA303
CA304
CA305
CA306
CA307
CREDITOR
NAME
CREDIT APPLICATION
I/We hereby apply to Creditor Name (hereinafter referred to as the ‘VENDOR”) for credit and/or an increase,
update or reconfirmation of our existing account.
Credit Line Requested:$ ____________________
Request for credit in excess of $5000: Please attach a copy of your most recent financial statement.
COMPANY INFORMATION
____________________________________________________________________________________
Complete Legal Name
____________________________________________________________________________________
Doing Business As
______________________________________________________(____)________________________
Billing Address Phone
______________________________________________________(____)________________________
City State zip Fax
Business entity:
Proprietorship Partnership Corporation LLC LLP
____________________________________________________________________________________
Date Business Established Year(s) Under Present Ownership
____________________________________________________________________________________
Date of Incorporation State of incorporation federal ID/SSN#
____________________________________ $_________________________________________
Resale# Gross Sales Last Year
PRINCIPAL OWNERS, OFFICERS AND PARTNERS

____________________________________________________________________________________
Name Social Security #
____________________________________________________________________________________
Home address City state Zip
(____)______________________________________________________________________________
Home Phone Number Driver License Number
____________________________________________________________________________________
Name Social Security #
____________________________________________________________________________________
Home Address City State zip
(____)______________________________________________________________________________
Home Phone Number Driver License Number
BANK REFERENCES (Attach separate sheet with additional information, if necessary)
______________________________________________________(____)________________________
Bank Tel
#___________________________________#_____________________________#_________________
Checking Account Saving Account Loan
____________________________________________________________________________________
Address
Business Credit Application

Name/Address
Last: First: Middle Initial: Title
Name of Business: Tax I.D. Number
Address:
City: State: ZIP: Phone:
Companv Information
Type of Business: In Business Since:
Legal Form Under Which Business Operates:
Corporation □ Proprietorship □
Partnership □
If Division/Subsidiary, Name of Parent Company: In Business Since:
Name of Company Principal Responsible for Business Transactions: Title:
Address: City: State: ZIP: Phone:
Name of Company Principal Responsible for Business Transactions: Title:
Address: City: State: ZIP: Phone:
Bank References
Institution Name: Institution Name: Institution Name:
Checking Account #: Savings Account #: Home Equity Loan: Loan Balance:
Address: Address: Address:
Phone: Phone: Phone:
Trade References
Company Name: Company Name: Company Name:
Contact Name: Contact Name: Contact Name:
Address: Address: Address:
Phone: Phone: Phone:
Account Opened Since: Account Opened Since: Account Opened Since:
Credit Limit: Credit Limit: Credit Limit:
Current Balance: Current Balance: Current Balance:
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the
understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby
authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is
being applied for in order to verify the information contained herein.
Signature Date
CUSTOMER CREDIT APPLICATION

(PLEASE PRINT OR TYPE)
Fax to: Creditor Fax Number
Mail Original to: Creditor Address
Date Prepared: __________________________________ Acct No. ________________________
1. ACCOUNT BILL-TO INFORMATION
NAME: _________________________________________
ADDRESS: _________________________________________
ADDRESS: _________________________________________ How long is business: _____________________
ADDRESS: _________________________________________ D&B DUNS #. __________________________
CITY: _____________________________ STATE: ____ # of employees: _________________________
ZIP: _______________ FED.TAX.ID# _____________ Annual Gross Sales Volume:_______________
PHOEN#: (____)______-______ FAX#: (____)______-_______ E-MAIL: ____________________________________
TAX EXEMPT RESALE CERTIFICATE#: ___________________________________________________________

(COPY MUST BE ATTACHED, OTHERWISE SALES TAX WILL BE ADDED TO ALL INVOICES)
BUSINESS CERTIFICATE: COPY MUST BE ATTACHED FOR VARIFICATION PURPOSES
ACCOUNT BUYER NAME:______________________________________________________ PHONE#._____________________
ACCOUNT PAYABLE CONTACT: ________________________________________________ PHONR#.____________________
PRINCIPAL(S):
1. NAME:_____________________________ HOME ADDRESS:________________________ SS#___________
DIVISION OR SUBSIDIARY OF: __________________________________________________
2. REFERENCES:
NAME OF BANK:__________________________________________________________________________________
ADDRESS:___________________________________________________ CONTACT: ___________________
CITY:________________________________ STATE:________________________________ ZIP: __________
PHONE#. (____)________-________ ACCOUNT#(1)._______________ ACCOUNT#(2).________________
NAME OF THREE MAJOR SUPPLIERS FROM WHOME CREDIT IS OBTAINED
1. COMPANY NAME _____________________________________________________ ACCOUNT NO:________________
ADDRESS (CITY,STATE,ZIP)____________________________________________ PHONE NO:___________________
ADDRESS (CITY,STATE,ZIP)____________________________________________ PHONE NO: ___________________
ADDRESS (CITY,STATE,ZIP)____________________________________________ PHONE NO:___________________
3. CREDIT LINE REQUESTED

$______________________ (IF OVER $10,000 YOU MUST ATTACH A COPY OF RECENT FINANCIAL STATEMENT)
APPROXIMATE VALUE OF INITIAL ORDER $________________________
ALL APPLICATIONS FOR WHOLESALE CUSTOMER STATUS MUST BE ACCOMPAINED BY A CUSTOMER AFFIDAVIT FORM
Should Creditor Name engage a collection agency and/or attorney at law to collect any outstanding balance upon default of this account, the
undersigned hereby agrees to pay the principle indebtedness, interest thereon, and reasonable collection/attorney fees. The undersigned
acknowledges that Creditor Name is under no obligation to extend credit to this account or, if credit is extended, to continue to extend such
credit. The undersigned further acknowledges that they have read, understand and agree to Creditor Name’s Terms and Conditions of sale.
This serves as authorization for Creditor Name to review the information contained in this application and authorizes the undersigned’s
bank and trade references listed above to release necessary information for credit approval.
SIGNATURE________________________ TITLE __________________________ DATE __________________

CREDIT APPLICATION FOR A BUSINESS ACCOUNT

BUSINESS CONTACT INFORMATION
Title:
Company name:
Telephone: Fax: E-Mail:
Registered company address:
City: State: ZIP Code:
Date business commenced:
Sole proprietorship: Partnership: Corporation: Other:
BUSINESS AND CREDIT INFORMATION
Primary business address:
How long at current address?
Bank name:
Type of account Account number
Savings
Checking
Other
BUSINESS/TRADE REFERENCES
Company name:
Address:
Type of account:
Company name:
Address:
Type of account:
Company name:
Address:
Type of account:
AGREEMENT
1. All invoices are to be paid 30 days from the date of the invoice.
2. Claims arising from invoices must be made within seven working days.
3. By submitting this application, you authorize _______________to make inquiries into the
banking and business/trade references that you have supplied.
SIGNATURES
Title: Title:
Date: Date:
!
SAMPLE CREDIT APPLICATION

Company Name __________________________ Address ______________________________
City _________________________ State _____________________ Zip Code ______________
Phone Number (_____) _____________________ Fax Number (____) ____________________
Other Business Address ____________________________________ City _________________
State ______________ Zip Code _________________ Phone Number # (____) _____________
Check One Corporation in State of _____ Partnership Proprietorship
Bank References:
Bank Name____________________________ Address ________________________________
City _________________________ State _______________________ Zip Code ____________
Phone # (____)_____________ Bank Officer _________________________________________
Trade references:
1. Name ______________________ Address _____________________________________
City ___________ State _________ Zip Code _________ Phone # (____)____________
2. Name ______________________ Address _____________________________________
3. Name ______________________ Address _____________________________________
List all persons authorized to sign for account
Name __________________________________ Signature ______________________________

(Print)
Name __________________________________ Signature ______________________________
(Print)
Name __________________________________ Signature ______________________________
(Print)
Personal Guarantee – I (we) the undersigned in consideration of (Your Company Name)

extending credit to (Prospect Company Name) hereby personally, and jointly and severally
guarantee payment of all debts incurred by (Prospect Company Name) to include but not limited
to legal and collection costs incurred.
Name __________________________________ Signature ______________________________

(Print)
Title ____________ Date ________ Home Address ____________________________________
City __________________ State _______________ Phone # (____)_______________________
Witness Name __________________ Witness Signature ________________________________
(Print)
CREDIT APPLICATION & PERSONAL GUARANTEE

INSTRUCTIONS: Print this form, fill it out, and Fax it to Creditor’s fax number
Date: ____________________
Legal Name ___________________________________________________________________

Trade Name if Any _____________________________________________________________
Address ______________________________________________________________________
Business Phone ________________________________Business Fax _____________________
Type of Business: Corporation _______Partnership ______Individual Business ____ Other ____
PRINCIPALS OR OWNERS:
1) Name___________________________ Home Address __________________________________
Business Title ____________________ Home Phone __________________SS#_______________
BANK REFERENCES
Name _________________________________ Account Number ________________________________
Address __________________________________________________________________________________
Name _________________________________ Account Number ________________________________
Address __________________________________________________________________________________
TRADE REFERENCES
1) Supplier Name: ______________________ Phone#:__________________ Fax#:__________________
We certify that the above information is true and correct and we agree to pay this account in accordance with
your credit terms. We authorize you to verify this information and/or obtain additional information by securing
data from a credit reporting agency. We understand that all past due balances will be 1 ½% per month service
charge. We further agree to pay 25 % collection charge, in the event of default, if the account is place with an
attorney or bonded collection agency.
CUSTOMER
Credit Application
To expedite processing please complete this form in its entirety. Incomplete

forms will be returned for completion thus causing processing delays.
Company Name_______________________________________________________________
Address_____________________________________________________________________
____________________________________________________________________________
City: _______________________ State: ____________________ Zip code: ______________
Phone #:______________________________ Cell #:_________________________________
Fax #:____________________________________ E-Mail:_________________________________
Principal: ______________________________ Title: __________________________________
Sole Proprietorship or Partnership or Corporation in the State of_________________________
Subsidiary of_____________________________ Division of_____________________________
Social Security #_________________________ Federal Tax # (EIN) _______________________
Has the firm or any of its Principals ever filed a bankruptcy petition? Yes No
If yes, explain: _______________________________________________________________
____________________________________________________________________________
How do you want your acknowledgements sent to you? _____mail _____fax _____e-mail
How do you want your invoices sent to you? ______________mail _____fax _____e-mail
How do you want your statements sent to you? ____________ mail _____fax _____e-mail
Trade References:
1) Company Name_______________________________________________________________
Address_____________________________________________________________________
City_________________________ State _________________Zip Code _________________
Phone Number: __________________________Fax Number: ___________________________
Account Number: _____________________________________________________________
2) Company Name_______________________________________________________________
Address_____________________________________________________________________
City_________________________ State _________________Zip Code _________________
Phone Number: ___________________________Fax Number: __________________________
Account Number: _____________________________________________________________
3) Company Name ______________________________________________________________

Address _____________________________________________________________________
City _________________________ State _________________Zip Code _________________
Phone Number: ___________________________Fax Number: ___________________________
Account Number: _____________________________________________________________
1
0204-AD
Credit Application and Personal Guarantee
BILLING/SHIPPING INFORMATION
OFFICIAL COMPANY NAME_______________________________________________________________________
SHIP TO______________________________________________________________________________________
BILLING ADDRESS_ ________________________________________________________________________________
CITY_ _________________________________________ STATE__________ ZIP___________________________
PHONE ________________________________________ F A X _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
E-MAIL_______________________________________________________________________________________
WEBSITE_____________________________________________________________________________________
BUSINESS INFORMATION
CHECK ONE CORPORATION PARTNERSHIP PROPRIETORSHIP SUBSIDIARY
YEARS IN OPERATION ________________________ TYPE OF BUSINESS___________________________
SALES TAX EXEMPTION #_______________________ SALES PER YEAR_____________________________
PRESIDENT / CEO_______________________________ TREASURER / CONTROLLER______________________
VP / FINANCE___________________________________ A / P M A N A G E R _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PRINCIPAL(S) / OWNER(S)
NAME____________________________________ SOCIAL SECURITY NUMBER _________________________
ADDRESS____________________________________________________________________________________
CITY ____________________________________ STATE _________ ZIP _________________________________
HOME PHONE_________________________________________________________________________________
ENROLLMENT FORM
FOR Membership # ________________
FREE MEMBERSHIP
Please print all information clearly:
_____________________________________________________ Check&all&that&apply:&
Name/First Middle Initial Last
&&&&&&&&I"hold"a"valid"seller’s"permit."
_____________________________________________________ """"""""(must"show"seller’s"permit"and/or"supply"
Business/Organization Name """"""""""State"resale"certificate)"""
"""""""""I"represent"a"non<profit"organization"with"
_____________________________________________________ """"""""Valid"proof"of"tax"exemption."
Business Street Address Apt./Suite# """""""""(must"supply"federal"or"state"tax"exemption"ID#.)"
""""""""I"want"to"pay"for"purchases"by"check."
_____________________________________________________ """"""""(must"fill"out"company’s"check"acceptance"application)"
""""""""""I"have"other"business"location."
City State Zip """"""""List"other"business"location(s)"by"name"and"zip"code."
(____)________________________(____)___________________ """"""""""_________________________________"
Business Phone Fax """"""""_________________________________"
""""""""_________________________________"
_____________________________________________________ """"""""_________________________________"
E-mail Address
_________________________________________ Others&who&are&entitled&to&use&my&membership&card:&
Home Street Address
__________________________________& """Business"partner"
_________________________________________ """Employee"
Name/First" " " Last"
Home City Home state Home Zip """Family"Member"
"
__________________________________" """Business"Partner"
(____)____________________________________ """Employee"
Home Phone Name/First" " " Last" """Family"Member"
"
In consideration for receiving a Creditor Name customer membership card, the undersigned has voluntarily
and freely entered into an agreement with Creditor Name, which will remain in effect with the following
stipulations until terminated with written notice:
1. I guarantee payments to Creditor Name for all my purchases.
2. I want to receive through the mail at my business any Creditor Name promotional materials.
___________________________ ______________________
Applicant Signature Date signed
__________________________________________________________________________________________
INTERNAL USE ONLY NEW DELETE CHANGE
MEMBERSHIP NUMBER:_______________________
LICENSE: EXPIRATION DATE

RESALE__________________________________/_____/_____ AREA (FMR CODE):_______
CIGARETTE______________________________/_____/_____ SIC: ______
BEER____________________________________/_____/_____ DEMO:______
WINE____________________________________/_____/_____
LIQUOR__________________________________/_____/_____
PREPARED BY:__________ DATE:__/__/__ INPUT BY __________DATE__/__/__ VERIFIED BY:__________ DATE __/__/__

COMMENTS:________________________________________________________________________________________________
____________________________________________________________________________________________________________
CREDIT APPLICATION
Business name: Phone No: ( )_________________ Date: / /
Fax No: ________________________
E-Mail: ________________________
Bill to Address: City: State Zip:
Ship to Address: City: State Zip:
Proprietorship: ________ Partnership:_______________ Federal Tax ID

Corporation: __________ Other: ___________________ #___________
Yes, I would like Creditor Name to Fax me weekly with current promotional information.
No, Don’t Fax me.
E-mail me instead. Email Address _____________________________________
Type of Business: Cross Streets: Receiving Hours: Special delivery Instructions:
Information of Owners, Partners or Principals

1.Name: Social Security No: Home Phone:
Home Address: Driver’s License: E-mail Address:
2.Name Social Security No: Home Phone:
Home Address: Driver’s License: E-mail Address:
Bank Name: Address: Account No:

1.
2.
Trade Reference Name: Address: Phone No:

1.
2.
3.
Financial Statement Estimated Credit Sales Representative:

Enclosed:________ Requirement:$_____________ ______________________________
Available Upon Request
You will find the terms of sales stated on our invoices. Jurisdiction for the enforcement of any transactions made, pursuant
to this credit application, shall be performed in Creditor’s County and State. All transactions taken place, pursuant to
this credit application, shall be performed in Creditor’s County and State. The laws and decisions of Creditor’s State
shall govern all transactions taking place between the parties. Any overdue payments shall bear charges at the rate of
eighteen (18%) percent per annum, except in no event shall the amount of the charges exceed the highest amount
permitted by law. Should it be necessary for us to retain an attorney to enforce any of the transactions, which may arise
between the parties pursuant hereto, the undersigned agrees to pay our attorney’s fees and costs of collections. Invoices
are payable at the offices of Creditor Name.
I hereby authorize Creditor Name to contact any and all of the above firms regarding our credit.
Owner’s Signature:_____________________________________________ Date : _____________________

CUSTOMER CREDIT APPLICATION

Territory _______________ Price Class _____________
Office Use
Terms _________________ Tax Code ______________ Date:&

TB County _____________ TB Map Location ________
Only
Credit Limit ____________
Approved _________________________ Y / N
BILLING INFORMATION SHIP-TO INFORMATION

FOR INTERNAL USE ONLY. PRIVATE AND CONFIDENTIAL
NAME OF BUSINESS NAME
LEGAL (IF DIFFERENT) ADDRESS
ADDRESS
1 CITY
CITY ST ZIP PHONE

( )
STATE ZIP PHONE NAME
( )
DESCRIPTION OF BUSINESS ADDRESS
NO OF EMPLOYEE CREDIST REQUESTED TYPE OF BUSINESS 2 CITY

ESTIMATED MONTHLY PURCHASE (Please check One) ST ZIP PHONE
( )
__<$1,000 __ $1,000 – $2,499 __ $2,500 – $4,999 __ $5,000 – $9,999__ >$10,000
BUSINESS STRUCTURE DELIVERY HOURS: _______AM - ________PM
CORPORATION PARTNERSHIP PROPRIETORSHIP RECEIVING INFORMATION:

NAME:_______________ PH:________________
DIVISION/SUBSIDIARY
NAME OF PARENT
COMPANY _________________________ PAYABLE INFORMATION:
NAME:_______________ PH:________________
IN BUSINESS SINCE _______________________________
RESALE# TAX PAYER ID #
COMPANY PRINCIPALS RESPONSIBLE FOR BUSINESS TRANSACTIONS

NAME: SSN: PHONE :( ) TITLE:
ADDRESS: CITY: ST: ZIP:
NAME: SSN: PHONE :( ) TITLE:
ADDRESS: CITY: ST: ZIP:
LEGAL HISTORY OF COMPANY / PRINCIPAL

In the last 7 years has the company or any principals ever:
Declared Bankruptcy Yes__ No __ A Lien Yes__ No __ Judgment Against Yes__ No__ if
yes to any of the above questions, please explain:
______________________________________________________________________________________
______________________________________________________________________________________
A
Business Credit Application-Page 1
Name of
Firm____________________________________________________________________________________________________
Billing
Address________________________________________________________________________________________________
___
Physical
Address________________________________________________________________________________________________
_
Phone_______________ Fax______________ Cell __________________ e-mail

address______________________________
Type of Business____________________________________
Corporation_____ Partnership_____ Sole Proprietorship_____
Federal ID Number__________________ Date of Establishment__________________
**Are you presently a Pacific Pride Cardholder? Yes__ No__**

Owners or Officers:
________________________________________________________________________________________________________
__________
Name Home Address (City, State and Zip Code) Social Security No. Date of Birth
________________________________________________________________________________________________________
__________
Name Home Address (City, State and Zip Code) Social Security No. Date of Birth
Accounts Payable Contact_________________________
Bank Reference: Name_____________________________________________________

Address___________________________________________________
Phone__________________ Contact______________________
Account No._______________ Account Type_________
Trade References: Name_____________________________________________________

Address___________________________________________________
Phone_____________________ Account #_____________
Name_____________________________________________________
Address___________________________________________________
Phone____________________ Account #_____________
Name_____________________________________________________
Address___________________________________________________
Phone___________________ Account #_____________
Present Fuel Supplier______________________________
Have you ever filed for bankruptcy protection? Yes__ No__ If yes, when?______
CA302, page 2
I have made the above statements in order to obtain credit. I certify that they are true and authorize a
credit investigation. Purchases are invoiced twice monthly and payment in full is due within 15 days.
Balances over 30 days will accrue finance charges in the amount of 1 ½ % per month (18% annually) In the
event that Creditor Name must bring action to recover unpaid amounts due from customer, Creditor Name
shall be entitled to reasonable attorney and/or collection fees and court costs. Venue for suit, if required, will
be Creditor’s County.
NOTWITHSTANDING THIS ACCOUNT IS ESTABLISHED IN THE NAME OF A BUSINESS, I PERSONALLY

GUARANTEE PAYMENT OF THE ACCOUNT (MUST BE AN OFFICER OR OTHER AUTHORIZED TO SIGN ON
BEHALF OF THE COMPANY)
________________________________________________________________________________________________________
______
Signature Title Printed Name Date
Terms of Use:
1. If there is any change in the ownership of Purchaser or if substantially all of the assets
of Purchaser are sold, Purchaser shall promptly notify Creditor Name of such sales
and Creditor Name shall have a lien on all the assets of Purchaser and a lien on the
proceeds of such sales to secure payment of all outstanding sums owed to Creditor
Name.
2. Purchasers right to purchase Creditor Name products may be terminated immediately

upon breach of any terms hereof or any other agreement with Creditor Name and
may be terminated upon notice by either party. Upon termination, Purchaser agrees
to immediately pay all outstanding sums owed to Creditor Name.
3. A $25.00 handling fee will be charged for all checks returned by the bank for any
reason.
_____________________________________________________
_________________________________
Signature/Title Date
CREDIT APPLICATION
AGREEMENT
GENERAL BUSINESS INFORMATION
Exact Company Name:
Accounts Payable Contact:
Accounts payable Contact Email:
Invoice Recipient Email:
Division or Subsidiary (circle one) of below parent:

Parent’s Name:
Financial Officer’s .Name/Title:
I wish to receive email communication from Creditor Name or its partners to learn about special offers
programs and more: Yes No
Bill To Ship To
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Fax: Phone:
Dun’s No:
REFERENCES instead of this section, a standard “Bank and Trades” form may be submitted with this
Bank Reference Business Credit Reference
Bank Name: Name:
Address: Address:
City: City:
State: State:
Zip: Zip:
Branch: Phone: Fax:
Phone: Fax:
Officer Handling:
Checking Acct. No:
Business Credit Reference Business Credit Reference
Name: Name:
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Fax: Phone: Fax:
By signing this application you agree that all sales made by Creditor Name are made pursuant
to the Creditor Name Standard terms and Conditions of Sale attached to this application. In the
event of litigation between us, you agree that the prevailing party shall be entitled to reasonable
attorney’s fees as determined by the court.
Name of Signatory: _____________________________ Date: _____________________
Signature of Partner or Officer: __________________________Title: ___________________

CA303, page 2
AUTHORIZATION TO RELEASE CREDIT INFORMATION
To: Financial Institution/(Or Referenced Company) ___________________________________

Attn: Credit Department, Accounting department
The undersigned has authorized Creditor Name to obtain credit information for the purpose of
establishing credit and/or extending credit.
Company Name: _______________________________________________________________
Account Number: ______________________________________________________________
Address: _____________________________________________________________________
Signature: ___________________________________________ Date: ___________________
Printed Name and Title: ________________________________________________________

RESELLER APPLICATION
Legal Business Name Trade Name-DBA Phone Number:

Fax Number
Year Started___________________________________ State of Inc. __________________________________

Federal I.D.#:__________________________________ Dun & Bradstreet#_____________________________
Web Site Address:___________________________________________________________________________

Parent Company Name:______________________________________________________________________
Address:__________________________________________________________________________________
City:__________________________________________ State:_______________________ Zip:____________
Do you require a purchase order # before we accept an order? Yes No
Have you ever filed for bankruptcy? Yes No If yes, please attach explanation.
A/P Contact _______________________________________________________________________________
E-mail address:_____________________________________________________________________________
Estimated Monthly Purchases. $ _______________________________________________________________
Terms Requested: COD Company Check Credit Card (Visa, master Card, American express only)
COD Post Dated Check Net terms – Credit Line requested $_________________
BANK AND TRADE REFERENCES MUST BE COMPLETED TO BE CONSIDERED FOR NET TERMS
**PLEASE INCLUDE CURRENT YEAR FINANCIAL STATEMENT WITH NET TERMS REQUESTS**
Financial statement must include a balance sheet and income statement.
Un-audited statement must be signed by the company’s owner/officer. The statement time period must be indicated.
Name:____________________________________________________________________________________
Home Address:_____________________________________________________________________________
City:____________________________________ State: __________________________ Zip:______________
Home Phone:_______________________________________________________________________________
Social Security#.____________________________________________________________________________
E-mail Address:____________________________________________________________________________
Bank References

CA304, page 2
Street Address City, State, Zip Code Account No
2. Name Contact Name Phone No
Street address City, State, Zip Code Account No
3. Name Contact Name Phone NO
Street Address City, State, Zip Code Account No
This credit application and agreement is submitted by Customer to Creditor Name in order to obtain trade credit.
Customer agrees to make payment in full to Creditor Name for all amounts due according to ASI’s Invoice on or before net due date.
Customer also agrees to pay interest on all amounts that are due, Interest will be charged as 1.5% per month or the highest rate
allowed by law. If customer should default in any payment(s), Creditor Name has reserved the right to declare all invoice amounts
due and payable without notice to Customer. Additionally, Customer will be responsible for all collection costs and attorney fees,
whether bill is filed or not in order to collect any delinquent amount. Customer also agrees to provide ASI with required credit
information on request and to provide an annual statement to Creditor Name as a addition for the continued extension of credit. The
undersigned certify that all the information contained herein and any attachment is true and correct to the best of their knowledge and
believe.
Customer agrees to adhere to credit service policies and procedures established by Creditor Name and published in Credit Name’s
catalogue.
Proprietorship, partnership and/or personal guarantee customer understand that Creditor Name may order a consumer report in
connection with this application and subsequent customer reports in connection with updating and reviewing the existing or future
extensions of credit. Upon request, the name and address of the consumer credit reporting agency furnishing such report to Creditor
Name will be provided.
The Federal Equal Credit Opportunity Act. Prohibits discrimination in any way in the granting of credit.
The Federal agency which administers companies with this law is the Federal Trade Commission, Washington, DC 26580.
Authorized Individual (Print Name) Signature Title Date
INDIVIDUAL PERSONAL GUARANTEE
I,_______________________________________, residing at_______________________________________

(Guarantor name) (Home address)
for good and valuable consideration, including the extension of credit which I hereby acknowledge as having
been received do hereby personally guarantee and promise to pay any obligation to Creditor Name on demand
for any indebtedness of ________________________________________ to Creditor Name which may
become due. (Company name)
This guarantee shall be a continuing and irrevocable guarantee and indemnity to Creditor Name, further, I
hereby subrogate any indebtedness of _______________________________ which it may have to me the
indebtedness of Creditor Name.
I do hereby waive notice of default, non- payment and notice thereof and to Jury trial and consent to all
renewals and modifications of extension of credit.
Date ________________________________ Signature _______________________________________
Social Security Number____________________________

Please attach personal financial statement of guarantor.
CREDIT APPLICATION AGREEMENT
Estimated Monthly Purchases: _____________________

Applying for: C.O.D. Company Check Date: ____________________
Net Billing Terms
Credit Applicant: ________________________________ Email: ____________________________________
___________________ Website: ___________________________________
Address __________________________ Years at this address __________ Phone # :(____) ________
City, State, Zip ________________________________________________________ Fax # :(____) ___________
APPLICANT, Hereafter referred to as “BUYER”. Hereby applies for credit in accordance with the terms and
conditions of CREDITOR NAME, hereafter referred to as “SELLER”.
PLEASE PRINT OR TYPE ONLY. ADD AS ADDENDUM “A” ANY INFORMATION NECESSARY
TO COMPLETE ANY SECTION OF THE CREDIT APPLICATION IF YOU HAVE INADEQUATE SPACE.
CORPORATION PARTNERSHIP INDIVIDUAL
Exact name of the applicant
(Trade or other name used)____________________________________________________________________________
Date of incorporation or
State of incorporation or registration of partnership
Registration of partnership________________________ or date business started_________________________________
Federal ID#____________________________________ social security#(if individual)____________________________
Credit Rating Service ____________________________ Credit Rating Service No. ______________________________
We must obtain a Resale Number prior to opening accounts. State ________________ Resale # ___________________
NAMES AND COMPLETE ADDRESSES, PHONE NUMBERS AND SOCIAL SECURITY NUMBERS
(Check box(es) at left and list correct information)
Principals if Corporation
Name:____________________________ Title: _____________Tel: ( )_____________________ Soc.Sec.# _________
Partners is Partnership Members if Limited Liability Company Individual if proprietorship

Residence Address: _________________________________________ Res. Tel. ( )____________________________


BUSINESS REFERENCESS (Phone & fax Numbers Must be Provided)

CA305, page 2
1. Business Name ________________________________________________Account# _______________

Address _______________________________________________________________________
City _____________________________ State _________________ Zip ____________________
Credit Limit _________________ Credit Terms________________ Phone (____) ____________
Person to contact ________________________________________ Fax (____) ______________
Address _______________________________________________________________________
City _____________________________ State _________________ Zip ___________________
Address _______________________________________________________________________
City _____________________________ State _________________ Zip ___________________
Address _______________________________________________________________________
City _____________________________ State _________________ Zip ___________________
PERSONAL GUARANTEE
In consideration of the granting and the extension of credit by CREDITOR NAME, hereinafter referred to as “SELLER” to
_________________________ , hereinafter referred to as “BUYER”, the undersigned does/do jointly and severally guarantee to pay
and be liable for all obligations due SELLER by BUYER, including collection costs and/or attorney’s fees. This shall be an open and
continuing guarantee and shall continue in force not withstanding any change in the form of such indebtedness or renewals or
extensions granted by SELLER without obtaining consent thereto and until expressly revoked by written notice delivered by
guarantor to SELLER. Any such revocation shall not in any manner affect liability as to indebtedness existing prior thereto or within 7
days of revocation. I/We do hereby waive notice of the acceptance of this agreement, notice of default or non-payment and waive any
action required by any status against the BUYER. No delay on SELLER’s part in exercising any right hereunder, or taking any action
to collect or enforce payment of any obligation hereby guarantee, either against the BUYER or any other person primarily or
secondarily liable with the BUYER, shall operate as a waiver of any such right or in any manner prejudice SELLER’s rights against
me/us. I/We agree that in the event of any time by said BUYER, SELLER shall be entitled to look to me/us immediately for full
payment without prior demand or notice.
Signature ____________________________________________________________ Date ___________________________________

Signature ____________________________________________________________ Date ___________________________________
Signature ____________________________________________________________ Date ___________________________________
Signature ____________________________________________________________ Date ___________________________________
NO APPLICATION FOR CREDIT WILL BE CONSIDERED WITHOUT COMPLETION OF THIS CREDIT APPLICATION
AGREEMENT IN ITS ENTIRETY. A COPY OF BUYER’S MOST RECENT FINANCIAL STATEMENT MUST BE ATTACHED.
CA305, page 3
TERMS AND CONDITIONS
1. All new Buyer accounts will be shipped C.O.D. cash or cashier’s check until credit is approved.
2. Price: Shortly before or after delivery, an invoice is mailed to Buyer, which invoice sets forth the price of the goods sold hereby, as
agreed upon between Buyer and Seller.
3. CLAIMS FOR SHORTAGE OR DAMAGE: All claims for shortage, price discrepancy charged on invoice and/or damage claim must
be made to seller in writing by return receipt requested mail within five days of discovery, but no later than fifteen (15) days from date of
delivery.
4. PAYMENTS: Payment is to be made to Seller at its business offices address shown on the front hereof. In the event Buyer fails to make
any payments when due to Seller, then any and all of Buyer’s account with Seller there shall become immediately due and payable.
5. GENERAL TERMS: Payment of this invoice is due upon presentation and shall be delinquent after the terms set forth on the invoice
and in no case later than after thirty (30) days. The following terms shall apply to all transactions in conjunction with the terms and conditions of
this invoice and/or credit application:
a) Deferred Price Differential – A 5% deferred differential is charged monthly on all outstanding obligations remaining
outstanding and unpaid after 90 days from date of invoice.
b) Interest on Delinquency – All past due obligations shall bear interest at the rate of 1.5% per month but in no event more than
the maximum amount allowed by law, in which event the interest rate shall be the maximum allowed by law.
c) Jurisdiction – The judicial system of Seller’s address shall be designated as having exclusive jurisdiction of any dispute
between Buyer and Seller.
d) Attorney’s fee’s – Buyer agrees to pay all costs and reasonable attorney fees incurred in collection of all past due invoices and
accounts. Buyer agrees to pay such tax in addition to the amount of each invoice.
6. LIMITATION OF LIABILITY, REPRESENTATION AND WARRANTIES. Seller shall not, under any circumstances, be liable for
special or consequential damages such as, but not limited to, damage or loss of other property or equipment, loss of profits or revenue, loss of
capital, loss of purchased or replaced goods, or claims of customers for service interruptions. Remedies of the Buyer set forth herein are
exclusive. The liability of Seller with respect to any contract or anything done in connection therewith, such as the performance or breach
thereof, or from the manufacture, sale, delivery, resale, installation or use of any goods covered by or furnished by SELLER, whether arising out
of contact, negligence, strict tort or under any other warranty or otherwise, shall not exceed the price of the goods upon which the liability is
based. There have been no express representations or warranties made by Seller with respect to the goods listed on the front thereof.
7. WAIVER: A waiver of any terms or conditions of the credit application and/or this invoice shall not be deemed a general waiver for
any other transaction.
8. DELAYS: Seller shall not be responsible for any damages to Buyer as a result of any delay in delivery. Any and all delivery dates given
by seller are estimated only. Buyer is cautioned to make allowances for delays and is warned that seller shall not be liable to Buyer for delays to
delivery.
9. SEVERABILITY. If any provision or clause of these terms and the conditions or the application thereof to any person or circumstance
is held invalid or unconscionable, such invalidity or unconscionability shall not affect other provisions or applications of the terms and conditions
which can be given without the invalid or unconscionable provision or application and, to this end, the provision of this document are declared to
be severable.
10. ENTIRE AGREEMENT. This agreement is to be interpreted together with any “Credit Application Agreement” previously entered by
Seller and Buyer. They may not be modified or terminated, except by a document in writing signed by the parties hereto at a date subsequent
hereof.
11. GUARANTY. In the event Buyer is a corporation whose stock is not publicly traded, Buyer agrees to provide seller a PERSONAL
GUARANTY executed by Buyer and spouse of Buyer.
12. NOTICE. Buyer warrants that Buyer will give written notice of any material changes of fact on the “Credit Agreement Application” to
seller within 30 days of any material change.
I/We, do declare that I/We have read and agree to the terms of this “Credit Agreement Application” and do hereby certify that the
information provided in this credit application consisting of three pages and any addendum “A” is true and correct. I/We agree to provide you
written notice of any change of data information within 30 days of any such change. I/We acknowledge that the information herein given is for
the purpose of obtaining credit terms from Seller and that Seller has relied upon this information and any supplement information extending
credit. I/We further represent that Buyer is solvent and able to pay its obligations as incurred and sign this agreement at
___________________________________________.
In addition, I/We authorize the release of bank and credit information from the bank(s) and vendors listed in this ‘credit Agreement
Application” to Creditor Name.
Signature ______________________________ Title ________________________ date ________________________

BANK REFERENCE
Bank Name __________________________________________________________________________________________________

Address ____________________________________________________________________________________________________
Checking Account# __________________________________Saving Account # __________________________________________
Account Opening Date _______________ Bank officer _______________________________Tel ____________________________
Fax ___________________________
CREDITOR NAME
CUSTOMER APPLICATION AND AGREEMENT
Customer hereby applies with Creditor Name and its affiliated companies, for an open account. Customer
hereby acknowledges that any extension of credit by Creditor Name and its affiliated companies, whether now
existing or hereinafter extended, shall be made in reliance on the representations made in this Application as
being accurate and correct and this Application, and all off the terms hereof shall apply to each such extension
contained herein.
Customer must complete each section of the Application and return it to company’s local branch for processing.
Company may, at company’s sole discretion and option, require customer to submit financial statements, tax
returns, or other evidence of financial suitability in order to process the Application. Company makes no
representations concerning Customer’s ability to qualify for an open account or extension of any amount of
credit. Company may, at Company’s sole discretion and option, reject or deny this Credit Application; refuse to
extend credit or any amount of credit to Customer; withdraw its approval, if so granted, of an open account to
Customer; or modify or reduce an amount of credit, if so extended, whether now or hereafter.
1. Customer Information
Business Name: ________________________________________________________________________
Type of Business: ________________________________________________________________________
Address: ____________________________________city______________state_________zip___
Mailing address: ____________________________________city______________state_________zip___
Phone No. ( ) ______________________________ Fax(____)_________________________________
Contact Person: ______________________________ E-mail Address ____________________________
Type of Entity: _______________Established:__________State:____________Fed Tax ID No:_______
(Corporation,Limited Liability company, DUNS No:___________
General or Limited Partnership,
Sole Proprietorship)
Name of Parent Company (if applicable)_________________________________________________________

If incorporated or LLC, enter year_____________ and state of formation_________, and list two(2) officers or
principals that are authorized to act on behalf of Customer:
Name:_____________________________________ Title:_____________________________
Name:_____________________________________ Title:_____________________________
If a sole proprietorship or partnership, enter year_________ and state of formation______________, and list
each sole proprietor or partner that is authorized to act on behalf of the Customer, their title, if any, their home
address, and their social security number. (If more than 2 partners, attach additional sheet)
Name:_________________Tel:( )__________________ SS#:_____________________
Home Address_____________________________________________________________
Name:_________________Tel:( )__________________ SS#:_____________________
Home Address:____________________________________________________________
Do you have a sales exemption certificate? _____________Yes ____________No
If yes, please attach a sale tax exemption certificate for each state in which you presently and/or
intend to do business. If no certificate is attached Customer will be charged appropriate tax rate
and amount on all transactions.
Has Customer ever filed bankruptcy? ______No ______Yes – attach a separate sheet with details.
Has customer even been sued for alleged non-payment of a debt? _____No_____Yes
If so, please provide information on date sued, nature of dispute, and resolution of dispute:
__________________________________________________________________________________________
__________________________________________________________________________________________
CA306, page 2
CUSTOMER APPLICATION AND AGREEMENT (cont.)
Page 2 of 4
Customer Information (cont.)

Please indicate if Customer requires any of the following on Invoices:
- Job number
- Purchase order number
- Name of person ordering
- Other information: _______________________________
Have you done business with Company in the past? ________No __________ Yes
If so, please show the account no., name of company, address, and approximate dates:_____________________
__________________________________________________________________________________________
If not, how did Customer hear about company? ___________________________________________________
__________________________________________________________________________________________
2. Bank Reference
Bank:_______________________________________ Bank:_______________________________________
Address:____________________________________ Address:____________________________________
___________________________________________ ___________________________________________
Telephone No.:_______________________________ Telephone No.:_______________________________
Contact:_____________________________________ Contact:____________________________________
Accounts Nos.: Account Nos.:
Checking:________________________________ Checking:________________________________
________________________________ ________________________________
Savings:__________________________________ Savings:_________________________________
__________________________________ __________________________________
Loans:___________________________________ Loans:__________________________________
___________________________________ __________________________________
3. Trade References.
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
___________________________________________ ___________________________________________
Contact:____________________________________ Contact:_____________________________________
Date Opened:________________________________ Date Opened:_________________________________
Terms:______________________________________ Terms:______________________________________
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
___________________________________________ ___________________________________________
Contact:_____________________________________ Contact:____________________________________
Date Opened:_________________________________ Date opened:_________________________________
Terms:______________________________________ Terms:______________________________________
CA306, page 3
Page 3 of 4
4. Insurance Information (General Liability and Property Damage).

(Attach copy of each Declaration page)
Ins. Company:________________________________ Ins. Company:________________________________
Address:_____________________________________ Address:____________________________________
____________________________________________ ___________________________________________
Contact:_____________________________________ Contact:_____________________________________
Policy No.:___________________________________ Policy No.:__________________________________
5. Agreement.
Customer agrees that the following terms shall apply to Customer’s accounts with Creditor Name and its
affiliated companies, and any and all obligations arising there from, and this supersedes any prior or other
similar agreement:
a. By Customer’s signature below, Customer confirms that all of the information provided by Customer in
this Credit Application and Agreement constitute representations upon which company can, and will,
rely, and that all such representations are true and complete.
b. Company is hereby authorize to obtain any other information which Company deems reasonably
necessary, from any source, either to verify the representations made in this Credit Application and
Agreement or to obtain other related credit information.
c. Customer will immediately notify Company in the event that any representation made in this Credit
Application and Agreement becomes untrue or in the event that Customer becomes insolvent or
otherwise unable to regularly pay its obligations as they become due.
d. Customer will pay, in full, each invoice provided to Customer by Company within 30 days of the date of
each invoice, unless Company has provided Customer, in writing, with different terms and, in that event,
Customer shall pay each invoice, in full, in accordance with those terms. Any amount not received by
Company when due shall bear interest at 2.0% per month or such maximum lesser rate as may be
permitted by law.
e. In the event that Company incurs any legal fees or related costs in connection with Customer’s account
with Company, either as a result of Customer’s failure to comply with terms of Customer’s account or
otherwise, Customer shall be required to immediately reimburse Company for any and all legal fees and
related costs incurred by Company.
f. Customer and Company expressly agree that the laws of the Creditor’s State shall govern the validity,
construction, interpretation, effect, and enforcement of this Credit Application and Agreement, and all
obligations arising pursuant thereto or otherwise as a result of the relationship established thereby, and
the Courts of the Creditor’s State shall have jurisdiction over the parties with respect thereto and any
litigation arising there from, which venue being established based upon the then corporate office
location of Company. Customer and Company further agree that this Agreement and all rental
agreements, delivery receipts, and all other documents applicable hereto, are deemed entered into, are to
be performed, and all amounts are payable at, the then corporate office location of Company.
g. A Signature on this Credit application and agreement transmitted by facsimile transmission shall be
effective as an original signature.
Dated: ___________________ Company: __________________________

___________________________________
Name: _____________________________
Title: ______________________________
[PERSONAL GUARANTY FOLLOWS]
CA306, page 4
Page 4 of 4
6. Personal Guaranty.
For, and in consideration of, the allowance of credit to Customer, I/We, the undersigned Guarantor(s)
personally guarantee, unconditionally and at all times, to Creditor Name and its affiliated companies, the
payment of all obligations, indebtedness, and liability which may be now or hereafter owing by Customer to
Creditor Name, in addition to any legal fees and costs incurred by Company in connection with the
enforcement of this Guaranty.
In connection with this Guaranty, I/We, the undersigned Guarantor(s), further agree as follow:
a. This Personal Guaranty shall be a continuing obligation and may not be revoked, except in writing
provided to, and actually received by, Company and, in the event of any such revocation, that revocation
shall not be effected as to any obligation, indebtedness, or liability which arose, credit extended,
equipment rented, or services rendered prior to Company’s receipt of that revocation.
b. In the event that Company incurs any legal fees or related costs in connection with Customer’s account
with Company or the enforcement of this Guaranty, either as a result of Customer’s failure to comply
with the terms of Customer’s account, Guarantor(s) failure to comply with the terms of this Guaranty, or
otherwise, Guarantor(s) shall be required immediately reimburse Company for any and all legal fees and
related costs incurred by Company.
c. The laws of the Creditor’s State shall govern the validity, construction, interpretation, effect and
enforcement of the Credit Application and agreement and of this Guaranty, and all obligations arising
pursuant thereto or otherwise as a result of the relationship established thereby, and the Courts of
Creditor’s State shall have jurisdiction over the parties with respect thereto and any litigation arising
there from, with venue being established based upon the then corporate office location of Company.
d. A signature on this Guaranty transmitted by facsimile transmission shall be effective as an original
signature.
__________________________________________________________________________________________
Guarantor: Guarantor:
Signature:___________________________________ Signature:___________________________________
Name:______________________________________ Name:______________________________________
Home address:________________________________ Home Address:_______________________________
____________________________________________ ____________________________________________
Social Security No.:___________________________ Social Security No.:___________________________
Driver’s License No.:____________State:_________ Driver’s License No.:_______________state:_______
Telephone Numbers:___________________________ Telephone Numbers:___________________________
___________________________ ___________________________
Date:_______________________________________ Date:_______________________________________
CA306, page 5
TERMS AND CONDITIONS
1. DEFINITIONS. The terms “Creditor Name” as used herein shall refer to Creditor Staining and misalignment to or of the Equipment or any part thereof; (e) wear
Name identified on the front page whom the Customer has rented the Equipment. resulting from use in excess of shifts for which rented; (f) freezing, and ;(g) any other
“Equipment” means any one or more of the items identified as such on the list page of damage to the Equipment which is not considered ordinary and reasonable in the
this Rental Agreement, and shall include any accessories, attachments or other cables, equipment rental industry. Repairs to the Equipment shall be made only by a facility
liquid fuel tanks, nozzles, and other similar items. “Customer” means the person or approved by Creditor Name, to the reasonable satisfaction of Creditor Name and in a
entity identified as such on the first page of this Rental Agreement, including any manner, which will not adversely affect the operation, manufacturer’s design or value
representative, agent, officer, or employee thereof. “Store Location” means the Baker of the Equipment.
address in the upper left-handed corner on the first page of the Rental Agreement. 11. LATE RETURNS. Customer agrees to pay for any damage to or loss of the
2. AUTHORITY TO SIGN. Any individual signing this contract represents and Equipment occurring between the time the Equipment is returned and the
warrants that he or she is of legal age, and has the authority and power to sign this commencement of Creditor Name’s next business day in the event the Equipment is
Rental Agreement as or for the Customer. returned to Store Location at other than Baker’s regular business hours.
3. DISCLAIMER OF WARRANTIES. CREDITOR NAME MAKES NO 12. RENTAL PERIOD & CALCULATION OF CHARGES. Rental charges
WARRANTIES, EXPRESS OR IMPLIED, AS TO THE MERCHANTABILITY commence when the Equipment is at the Store Location and end when the Equipment
OF THE EQUIPMENT OR ITS FITNESS FOR ANY PARTICULAR PURPOSE. is returned thereto. Rental charges occur during full week including Sundays and
There is no warranty that the Equipment is suited for Customer’s intended use, or that it Holidays. Rental rates are for normal usage based on an eight hour day, 56 hour a week
is free from defects. Except as may be specifically set forth in this Rental Agreement, 224 hours per month. On power equipment, Operation in excess of one shift (eight
Creditor Name disclaims all other warranties, either expressed or implied, made in hours per day, 56 hours per week and 224 hours per month) will be at Creditor
connection with this rental transaction. These warranty provisions cannot be amended Name’s standard premium rates. Customer will truthfully and accurately certify to
or modified orally or in writing and supersedes any contrary representations or Creditor Name the number of shifts the Equipment was operated. Transportation costs
warranties, expressed or implied. In addition, Creditor Name shall not be responsible for delivery and pick up and rent for Equipment covered by this Rental Agreement shall
for any damage or loss caused by negligence of Creditor Name’s employees or agents be in accordance with Creditor Name’s Rate sheet in effect from time to time. The
occurring in connection with the performance of the Rental Agreement. Equipment is furnished F.O.B. Creditor Name’s branch and all handling and
4. INDEMNITY/HOLD HARMLESS/DAMAGES. Customer acknowledges and transportation charges to and from Creditor Name’s branch, unless otherwise specified
assumes all risks inherent in the operation and use of the Equipment by Customer, and herein, shall be paid by Customer.
will take all necessary precautions to protect all persons and property from injury or 13. DEPOSIT. In addition to securing the payment of rental charges hereunder,
damage while in possession of the Equipment. Creditor Name shall not be responsible customer agrees that any rental deposit shall be deemed to be a guaranty by Customer
to Customer or any other party for any loss, damage or injury (including any loss of of the full and complete performance of each and all of the terms, covenants, and
profits, business interruption or other special or consequential damages) caused by, agreements to be performed by Customer hereunder, and in the event of any breach by
resulting from, or in any way connected with the Equipment, its operation or use, or customer thereof said deposit shall be credited against any damages, costs or expenses
any defect with respect thereto. Customer agrees to defend, indemnify and hold Baker incurred by Baker as a result of such breach.
harmless from and against any and all liability, claims and damages of any kind 14. PAYMENT. All obligations under this Rental Agreement shall be paid in full upon
(including attorney’s fees) for injuries or death to persons and damage to property return of the Equipment to Creditor Name or within 30 days after Creditor Name’s
arising out of the use, maintenance, instruction, operation, possession, ownership or Customer, whichever occurs first. Customer acknowledges that timely payment of
rental of the Equipment, however caused. rental charges is essential to Creditor Name’s business operations and it would be
5. RECEIPT & INSPECTION OF EQUIPMENT. Creditor Name or Creditor impractical and extremely difficult to fix the actual damages caused by late payment.
Name’s designee shall deliver the Equipment described on the face hereof to the site Customer and Creditor Name agree that there shall be added to all past due rental
designated by the Customer, as noted on the face hereof. Customer agrees not to charges, a late payment fee equal to the lesser of 2% per month (24% per annum), or
remove the equipment from that location without the prior written consent of Creditor the maximum amount allowed by applicable law.
Name, except in the case of equipment specifically designed and intend for mobility. 15. FAILURE TO DELIVER. Customer releases and discharges Creditor Name
Customer acknowledges by signing this Rental Agreement that Customer has inspected from any and all liability or damages (including consequential and special damages)
the Equipment prior to taking possession thereof, finds it in good working order and which might be caused by Creditor Name’s failure or inability to deliver any
repair, and suitable for Customer’s needs. Customer acknowledges that, although the Equipment by any specified date or time.
Equipment has, prior to delivery, been cleaned in accordance with Creditor Name’s 16. TITLE/NO PURCHASE OPTION/NO LIENS. This Rental Agreement is not a
usual procedures, Creditor Name does not warrant that the Equipment is entirely free contract of sale, and title to the equipment shall at all times remain with Creditor
of any contaminants, about a separate specific written agreement to the contrary, and Name. Unless covered by a specific supplemental agreement signed by Baker, the
Customer accepts the Equipment in its condition as when delivered. Customer is customer has no option or right to purchase the Equipment. Customer shall keep the
familiar with the proper operation and use of each item of Equipment. Customer has Equipment free and clear of all mechanics and other liens and encumbrances.
inspect all hitches, bolts, safety chains, hauling tongues, welds and other devices and 17. TIRE/TUBE REPAIR OR REPLACEMENT. Repair or replacement of tires is
material used to connect the Equipment to Customer’s towing vehicle, if any, Creditor the responsibility of the Customer, and is not included in the rental rate.
Name is not responsible for any damage to Customer’s towing vehicle caused by 18. DEFAULT. Should Customer in any way fail to perform, observe or keep any
detachable hitches or mirrors. provision of this Rental Agreement, Creditor Name may, at its option, do any one or
6. USE OF EQUIPMENT. Customer will not use or allow anyone to use the more of the following; (a) terminate the Rental Agreement; (b) declare the entire rent
Equipment: (a) for an illegal purpose or in an illegal manner. (b) Without a license, if immediately due and payable and commence legal action therefore; (c) retake
required under any applicable law, or (c) who is not qualified to operate it. Customer possession of the Equipment, holding the Customer liable for all rental and other
agrees, at Customer’s sole expense, to comply with all applicable municipal, state, and charges; or (d) pursue any other remedies available by law.
federal laws, ordinances and regulations (including O.S.H.A) which may apply to the 19. REPOSSESSION OF EQUIPMENT. In the event of any actual or anticipatory
use of the Equipment. Customer agrees that the Equipment shall be used only in the violation of or default in, any of the terms and conditions of this contract by the
normal course of its business, and only as to commodities, weight and other limitations Customer, Creditor Name’s employees or agents may terminate the rental and without
of the Equipment. Customer shall keep the Equipment in good and efficient working notice or legal process, go upon Customer’s property and take all action reasonably
order. Condition and repair, reasonable wear and tear alone accepted. Customer agrees necessary to repossess the Equipment. Customer waives all claims for damages and
to properly maintain and care for Equipment and further, to protect the health and losses, physical or pecuniary, caused thereby, and shall pay all costs and expenses
safety of the persons required to come in contact with the Equipment. Customer agrees incurred by Creditor Name in retaking the Equipment. Should Customer claim that
to check filters, oil, fluid levels, tire air pressure, clean and visually inspect the any of said Equipment contains property belonging to Customer; the Customer shall
Equipment daily and immediately notify Creditor Name when Equipment needs repair give written notice to Creditor Name of such fact within a period of 24 hours after
or maintenance. Customer acknowledges that Creditor Name has no responsibility to retaking by Creditor Name. Failure to give such notice within 24 hours shall forever
inspect the Equipment while it is in Customer’s possession, although Creditor Name bar Customer from asserting any claim or claims against on account of warranty
has the right, in its discretion, to conduct such an inspection and to test any contents alleged to have been said retaken Equipment.
which may be contained in the equipment, and to access Customer’s premises for that 20. CUSTOMER’S INSURANCE COVERAGE. Customer agrees to maintain and
purpose. Creditor Name shall incur no liability whatsoever for failure of the carry, at its sole cost, adequate liability, physical damage, public liability, property
Equipment to perform in customer’s service, nor for any damage to cargo(es0 owned damage and casualty insurance for the full replacement cost of the Equipment,
by Customer might be held responsible. Customer will not store or inject any materials including all risks of loss or damage covered by the standard extended coverage
that may cause harm to the equipment. Customer will not store or transport any acute endorsement to cover any damage or liability resulting from the handling,
hazardous materials unless Supplemental Acute hazardous Material Agreement has transportation, maintenance, operation or use of the Equipment during the entire rental
CA306, page 6
been signed by both parties prior to the rental. If any such acute hazardous materials are period. When requested, Customer shall supply to Creditor Name proof of such
stored or transported in the Equipment, Customer agrees that Customer shall be deemed insurance by certificate of insurance clearly setting forth the coverage for the
to be the generator of those materials and shall, upon request, prove customer’s EPA or Equipment and naming Baker as loss payee and additional insured: such insurance and
other environmental licensing number to be used by Creditor Name in connection evidence thereof to be in the following limits: (i) in the case of bodily injury liability
with the disposal of any such Acute hazardous Materials. Some Equipment is equipped (including death), $ 1,000,000 per person and $1,000,000 per occurrence and (ii) in the
with pressure/vacuum relief devices or throttle stop and governor devices. Customer case of property damage liability $1,000,000 per occurrence and in a form satisfactory
agrees not to tamper with or adjust such devices without prior consent of Creditor to Creditor Name. The Certificate of insurance and policy shall provide that Creditor
Name management. Name shall receive not less than (30) days notice prior to any cancelation of the
7. IMPROVEMENT OR CHANGES TO EQUIPMENT. Customer shall not (except insurance required hereunder.
as required by Section 6 hereof) make any substantial changes in or improvement to the 21. ENTIRE AGREEMENT/ONLY AGREEMENT. This written Rental Agreement
Equipment without the advance written consent of Creditor Name. Any improvements together with Creditor Name’s Credit Application, which Customer has provided to
or additions applied to the Equipment shall at once become and remain the property of Baker, represents the entire agreement between the Customer and Creditor Name. In
Creditor Name. Creditor Name reserves the right to charge the Customer for the the event of any conflict in terms, this Rental Agreement shall control. There are no
removal of any modifications that were made during the rental. oral or other representations or agreements not included herein. None of Creditor
8. MALFUNCTIONING EQUIPMENT. Should the equipment become unsafe, Name’s rights may be changed and no extension of the terms of this Rental Agreement
malfunction or require, Customer shall immediately cease using such Equipment and may be made except in writing, signed by both Creditor Name and Customer. The use
immediately notify Creditor Name. If such condition is the result of normal operation, of Customer’s purchase order number on this Rental Agreement is for Customer’s
Creditor Name will repair or replace the Equipment in working order if such convenience only. This Rental Agreement supersedes any purchase order or other
replacement Equipment is available. Creditor Name has no obligation to replace Customer provisions or forms whether sent to or received prior, or subsequent to this
Equipment rendered inoperable by misuse, abuse or neglect. Customer’s sole remedy Rental Agreement.
for any failure or defect in Equipment shall be the termination of any rental charges 22. NO ASSIGNMENT, LENDING OR SUBLETTING. Customer shall not
accruing after the time of failure. The Equipment must be returned to the Store sublease, sub rent, assign or loan the Equipment, and any such action by Customer shall
Location within twenty-four from the time of defect in order to terminate rental be void. Customer agrees to use and keep the Equipment at the job site set forth on the
charges. front page of this form unless Creditor Name approves otherwise in writing. Written
9. RETURN OF EQUIPMENT, DAMAGED & LOST EQUIPMENT. At the notice from Creditor Name is not required for temporary changes in the usual course
expiration of the rental, the customer will return the Equipment in the same condition of the Customer’s business.
as when delivered to the customer, empty of all contents in clean condition, usual wear 23. OTHER PROVISIONS. Any failure of Creditor Name to insist upon strict
and tear excepted. Additionally, Creditor Name reserves the right to charge for any performance by Customer of any terms and conditions of this Rental Agreement shall
repairs that may be necessary, including cleaning of interior or exterior and disposal of not be construed as a waiver of Creditor Name’s right to demand strict compliance.
any contents. Customer shall be liable for all damages to or loss of the Equipment, Customer has carefully reviewed this Rental Agreement and waives any principle of
including, but not limited to: (i) vacuum or pressure damage; (ii) tilting or upset due to law which would construe any provisions hereof against Creditor Name as the
unbalanced load; (iii) overloading; (iv) internal damage caused by adverse affects of draftsperson of this Rental Agreement.
cargo or mixture of cargoes, cleaning solvents and/or cleaning processes undertaken by Customer agrees to pay all reasonable costs of collection, court, attorney’s fees
Customer or its agents and any damage during transit to or from Customer; (v) and other expenses incurred by Creditor Name in the collection of any charges due
cavitations; (vi) freezing, improper operation, improper maintenance/lubrication, fire, under this Rental Agreement or in connection with the enforcement of its terms or
theft, windstorm, hailstorm, flood, riot, insurrection, strike, explosion, collision, otherwise in connection with this agreement or the Equipment whether or not litigation
damages during unloading, damages during transportation. Customer shall pay is commenced. Customer shall pay the rental charge without any offsets, deductions or
Creditor Name the reasonable costs of transportation, repair and pay rental on the claims.
Equipment at the regular rental rate until all repairs have been completed. Creditor Customer agrees that the Courts of Creditor’s County, State, shall, in Creditor
Name shall be under no obligation to commence repair work until Customer has paid Name’s discretion, have exclusive Jurisdiction, and shall be considered the proper
to Creditor Name the estimated cost therefore. In the case of the loss or destruction of venue, for any litigation relating to this agreement or Equipment related hereto, and that
any Equipment, or inability or failure to return same to Creditor Name for any reason the laws Creditor’s State shall be applicable thereto. Trial by Jury is waived. Service
whatsoever, customer will pay Creditor Name the then full replacement list price of process may be affected by certified mail. Creditor Name shall be entitled to
together with the full rental rate as specified until such Equipment is replaced. decrease of specific performance (without posting band or voiding warranty) in
10. REASONABLE WEAR AND TEAR. Reasonable wear and tear of the Equipment addition to such other remedies as may be available.
shall mean only the normal deterioration of the Equipment caused by ordinary and
reasonable use on a one shift (eight hours per day, 56 hours per week, and 224 hrs per
month) basis. The following shall not be deemed reasonable wear and tear; (a) damage
resulting from lack of lubrication of necessary oil, water and air pressure levels. (b)
Damage resulting from lack of servicing or preventive maintenance suggested in the
manufacturer’s operation and maintenance manual. (c) damage resulting from any
collision, overturning, or improper operation, including overloading or exceeding the
rated capacity of the Equipment; (d) damage in the nature of dents, bending, tearing,
COMMERCIAL CREDIT APPLICATION, AGREEMENT, AND GUARANTEE
This agreement dated ______________is made between Creditor Name and the
Customer ("Customer") in accordance with the following terms:
CUSTOMER CONTACT INFORMATION
Full Legal Business Name: _____________________________________________________

Trade Name: ________________________________________________________________
Street Address: ___________________________________________________________
________________________________________________________________________
Mailing Address: __________________________________________________________
Contact Person Name & Title: _______________________________________________
Business Telephone: _______________________________________________________
Business Fax: ____________________________________________________________
Pager Number: _______________________Cell Number: __________________________
Email Address: ___________________________________________________________
BUSINESS INFORMATION
Check Type of Business:

Corporation _____ Limited Liability Co. (L.L.C.) _____ Sole Proprietorship_____
General Partnership _____ Limited Partnership (LP) _____ Joint Venture _____
Other (Describe) __________________________________________________________
Date Business Formed/Incorporated: __________________________________________
State of Formation/Incorporation: ____________
Federal Tax ID No. for Business: _____________________________________________
Owners/Partners/Officers/LLC Members as Personal Guarantors:
Full Name: _______________________________Title: ____________________________

Street Address: ____________________________________________________________
Mailing Address: ________________________________________________________
Telephone: ________________________________Cell Phone: ______________________
Social Security#: ________-________-________ Email: __________________________
________________________________________________________________________
Full Name: _______________________________Title: ____________________________
Street Address: ____________________________________________________________
Mailing Address: ________________________________________________________
________________________________________________________________________
Full Name: _______________________________Title: ____________________________
Street Address: ____________________________________________________________
Mailing Address: ________________________________________________________
________________________________________________________________________
CA307, page 2
!!
Full Name: _______________________________Title: ____________________________
Street Address: ____________________________________________________________
Mailing Address: _________________________________________________________
Attorney Name and Telephone: ______________________________________________
Attorney Address: ________________________________________________________
CREDIT INFORMATION
Banking Information:
Bank Name: ____________________________ Account No: ______________________
Address: ________________________________________________________________
Contact Person: ______________________________________________________________
___________________________________________________________________________
Address: ________________________________________________________________
Contact Person: ____________________________________________________________
_________________________________________________________________________

Address: ________________________________________________________________
Contact Person: ______________________________________________________________
___________________________________________________________________________
Credit/Trade References:
Name of Reference: _______________________________________________________

Address of Reference: _____________________________________________________
Telephone Number: _______________________________________________________
Credit History:
Has the business or any individual with ownership interest filed for bankruptcy?
__________Yes ___________No
Are there any outstanding judgments against the company or any individual with ownership
interest in the company? __________Yes _________No
Has the business or any individual with ownership interest ever filed an assignment for the
benefit of creditors? ___________Yes _________No
CA307, page 3
Is there any pending or threatened litigation against the company and/or any individuals with
ownership interest in the company? ________Yes ________No
Has the company issued any checks which were not paid due to insufficient funds within the
past 6 months? __________Yes _________No
If the answer to any of the foregoing questions is YES and there are extenuating circumstances
for which you wish to provide an explanation:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
REPRESENTATIONS AND AUTHORIZATIONS OF CUSTOMER
The undersigned represent to Creditor Name:

1. The information contained in this Credit Application, Agreement and Guarantee is complete
and accurate and may be relied upon by Creditor Name.
2. We authorize Creditor Name and its agents to contact all credit and trade references as may
be required to verify our personal and business credit and business standing with them.
3. If we order materials for use on property owned by others, we represent that we shall have
in place a written contract with each such property owner or general contractor in compliance
with all applicable laws, rules and regulations of Creditor’s State.
4. In the event Creditor Name exercises rights under the Creditor’s State Construction
Lien Law, We agree to use either the American Arbitration Association or any other
alternative dispute resolution mechanism selected by Creditor Name.
5. We understand that payment of invoices is due on or before the last day of the month
following delivery and that service charges shall be levied on all invoices unpaid as of the
last day of the month following delivery. The current service charge on unpaid balance is
1 1/2% per month (18% per annum): this amount may be changed by Creditor Name and
any change will be reflected on Customer's invoice.
6. If we fail to pay invoices when due or otherwise default under the terms of this
Agreement, We shall pay all collection costs and expenses, including collection agency
fees and reasonable attorneys' fees of 25% of the unpaid balance.
7. We understand that a signed delivery slip is required for each shipment from Creditor
Name and that such signed delivery slip shall serve as a contract between Creditor Name
and us. If at the time of delivery, neither we nor our duly authorized representative is
available to sign the delivery slip, then as a convenience to us, we hereby authorize and
direct Creditor Name to sign the delivery slip on our behalf and we agree to pay for
goods so shipped upon receipt of Creditor Name’s invoice.
8. We understand that Creditor Name ships goods based upon written purchase orders and
that each such order shall serve as a contract between Creditor Name and us. If we or our
duly authorized representative is not available to sign the order at the time placed, then
solely as a convenience to us, we hereby authorize Creditor Name to sign the purchase
order as our agent and we agree to pay for goods so shipped and delivered upon receipt of
Creditor Name’s invoice.
9. For each building site to which Creditor Name will be making deliveries for us, we shall
provide Creditor Name with a completed Project Information Sheet at the time of
Customer's initial order for that site.
10. We agree to the terms and conditions of this Agreement, including the Additional Terms
of the Credit Application, Agreement and Guarantee terms.
CA307, page 4
PERSONAL GUARANTEE
In consideration of Creditor Name extending credit to Customer, we individually, jointly and

severally do hereby personally and unconditionally guarantee to Creditor Name the payment of
indebtedness of the Customer, including any and all costs of collection, including collection
agency fees and reasonable attorney's fees of 25% of the unpaid balance. The undersigned waives
notice of acceptance of this guarantee by Creditor Name and notice of default or of non-
payment on any of the liabilities. The use of any titles shall in no way be deemed to limit the
personal guarantee. Any change in ownership interest or relationship of Guarantor to Customer
shall not relieve Guarantor of obligations under this personal guarantee unless prior written notice
is provided to Creditor Name.
This Guarantee shall be a continuing guarantee and shall remain in effect subject to
discontinuance as to any of the undersigned only upon actual receipt by Creditor Name of 30 days
written notice from undersigned, provided no such notice of discontinuance shall impair or effect
any of the agreements or obligations incurred with respect to any and all liabilities existing prior to
the time of such actual receipt by Creditor Name of such discontinuance notice.
Guarantor agrees by signing this Guarantee Agreement to authorize Creditor Name and its agents to
investigate his business and personal credit history.
ADDITIONAL TERMS OF THE CREDIT APPLICATION,

AGREEMENT AND GUARANTEE
Agreement: "Agreement" as used herein shall mean all information, terms and conditions
contained in this Credit Application, Agreement, and Guarantee.
Payment Terms: Invoices shall be due and payable on or before the last day of the month
following delivery and services charge of 1 1/2 % per month (18% per annum) shall be charged on
all invoices unpaid as of the last day of the month following delivery. Creditor Name shall
have the right to modify its payment terms upon 60 days notice to Customer and Guarantor.
Notice shall be made by written notice mailed to Customer and Guarantor. Such notice shall be
deemed given upon mailing.
Signed Delivery Slips: A signed delivery slip shall be required for each shipment from Creditor
Name and each such signed delivery slip shall serve as a contract between Creditor Name and
Customer. If at the time of delivery, neither Customer nor its duly authorized representative is
available to sign the delivery slip, then as a convenience to Customer, Customer hereby
authorizes Creditor Name to sign the delivery slip as Customer's agent.
Written Orders: A written purchase order shall be required for each shipment from Creditor Name
and each order shall serve as a contract between Creditor Name and Customer. If neither Customer
nor its duly authorized representative is available to sign the order at the time placed, then as
a convenience to Customer, Customer hereby authorizes Creditor Name to sign the purchase
order as Customer's agent.
Special Delivery Instructions: If job-site delivery requires off-site access and delivery is placed
where instructed by Customer, Creditor Name shall not be responsible for any resulting
damages.
CA307, page 5
!!
No Warranties: THERE ARE NO WARRANTIES, EXPRESS OR IMPLIED OF
MERCHANTABILITY, FITNESS FOR ANY PARTICULAR PURPOSE, OR OTHERWISE,
WITH RESPECT TO ANY PRODUCT.
Effect of Installation: Any claims for defects or incorrect items discoverable prior to installation
are forever waived as soon as the product is actually installed. Do not install defective or
incorrect product.
Resale Certificate: If Customer delivers to Creditor Name a Resale Certificate, Customer

represents and warrants that the Resale Certificate is valid and that Customer is entitled to be
excused from the payment of otherwise applicable sales and use taxes.
"As Is" Sale: Product described as "Seconds", Rejects", "Without Warranty", "As Is",
"Damaged", "Off-Grade", or other similar designation is sold "As Is", without recourse and
without warranty, express or implied. In such cases, Creditor Name shall not be responsible for
any defect, loss, damage, or injury caused by or related, directly or indirectly, to such product.
Delayed Delivery: Creditor Name shall not be liable for any damages whatsoever arising out of
delay in delivery. Stated dates of delivery are Creditor’s Name best approximation as to when
delivery is likely to occur. "As soon as possible" or words to that effect are not sufficient
expression of an essential time schedule.
Natural Products: ANY PRODUCT CONSISTING OF OR CONTAINING ANY NATURAL
MATERIAL SOLD BY CREDITOR NAME IS SUBJECT TO VARIATIONS INHERENT IN
A NATURAL PRODUCT. SUCH PRODUCT WILL EXPAND AND CONTRACT
SEASONALLY AS WELL AS WITH ALL CHANGES IN TEMPERATURE AND
MOISTURE. REAL WOOD BOASTS UNIQUE CHARACTERISTICS AND GRADATIONS
OF COLOR; GRAINING AND OTHER FEATURES WHICH ARE HALLMARKS OF
NATURE'S OWN MATERIALS, NO SUCH GRADATIONS, VARIATIONS OR
CHARACTERISTICS SHALL CONSTITUTE A DEFECT UNDER THE LIMITED
WARANTY.
Samples: All specimens exhibited or submitted by Seller as samples are intended only as an
indication of general and surface characteristics, and the general layout, color and finish. The
cross- section and backing material of such samples do not indicate the product to be sold by
Seller, but are for display purposes only.
Quotations: Unless stated in writing otherwise quoted prices represent the offer of Seller on
described product, which shall remain firm for immediate acceptance only, and are subject to
change without notice thereafter.
Special Order: "Special Order" shall be defined as an order for any product not regularly
stocked by Creditor Name. In the event Customer rejects delivery, cancels or otherwise
modifies any Special Order for which Creditor Name will be charged by its supplier, Customer
shall be responsible for payment to Creditor Name of all costs and charges imposed upon
Creditor Name by its supplier, including but not limited to the full cost of the Special Order
and/or any cancellation fee or restocking fee. Any deposit paid to NSL for such special order
shall be forfeited.
Default: Customer shall be in default under this Agreement if (i) Customer fails to make
payments in full when due, (ii) fails to keep any promise in this Agreement, (iii) any
representation by Customer in this Agreement is false; or (iii) the legal entity (such as
corporation, partnership or limited liability company) which has agreed to make payments under
CA307, page 6
!!
this Agreement merges, dissolves, reorganizes, terminates its business or existence or becomes
ineligible to do business in Creditor’s State .
Indemnification: If Creditor Name is named as a defendant in any action as a consequence of

actions taken in reliance on Customer's representations under this Agreement. Customer shall
indemnify and hold NSL harmless from any such action and Customer agrees to pay all
Creditor’s Name costs to defend against such action, including reasonable attorney's fees.
Collection Costs: If customer defaults under the terms of this Agreement. Customer agrees to pay
all collection costs and expenses, including court costs and reasonable attorney's fees of 25% of
the unpaid balance.
Masculine/Feminine/Singular/Plural: All references to masculine shall include the feminine and
all references to singular shall include plural.
Governing Law: This Agreement shall be governed by the laws of Creditor’s State. Terms
and Conditions Subject to Change. The terms and conditions contained herein are subject to
change by NSL at any time.

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THE CREDIT

85% SUCCESS RATE ON LARGE VIABLE CLAIMS

© The Kaplan Group 2014

Collect information to Establish terms Get protections

We have included over 20 sample credit applications. You can download

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CREDIT APPLICATION ESSENTIALS

Personal Guaranty Provide Financial Statements

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1. Overview: Why do Credit Applications Exist and General Considerations ......... 5

2. Information required to evaluate credit .............................................................. 8

3. Terms of granting credit ..................................................................................... 14

4. Terms to protect creditor if customer defaults ................................................. 20

7. Checklist to evaluate your current or proposed credit application ................... 36

8. Our 2 Favorite Credit Application Templates .................................................... 40

9. Over 17 sample credit applications .................................................................... 44

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The credit application (Application) is the

This is the time when customers typically will agree to industry

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Next: Information Required To Evaluate Credit

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2A. BASIC IDENTIFICATION INFORMATION

Who they are (name); Who is the owner;

The amount and

In deciding what information to request, we recommend

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SAMPLE FORM: BASIC IDENTIFICATION INFORMATION

Legal Business Name ___________________ Trade Name – DBA _________________________

Are you a: Subsidiary □ Division □ Parent Company Name: ____________________________

Check One □ Principal/Owner □ Partner □ Proprietor

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2B. TRADE AND BANK REFERENCES

Trade References (Major Suppliers)

1. Name ______________ Contact ______________ Phone Number ________________

Name ____________________ Contact Name ______________ Phone # ______________

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2C. LESS COMMONLY REQUESTED INFO

2 Former business address

2 List of all owners (name, title, and social security number)

2 Estimated annual sales

2 Mortgage holder or landlord (name, phone, address)

2 Any outstanding liens or judgments

2 Any current or threatened litigation

2 Any NSF checks in last six months

If you have a specific reason for requesting any

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2D. SIGNATURE BLOCK

Next: Terms of Granting Credit

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3A. BINDING AGREEMENT

3B. AUTHORIZED TO EXECUTE

Legal Business Name _ Trade Name – DBA _______

1. Name Contact Phone Number ____

Name ____ Contact Name Phone #

Name Title Signature _ Date