Our Credit Application FILL IN ALL BLANKSName of person completing application *Business Name *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePhone # *Fax #Email Address *Nature of BusinessFederal I.D. or Social Security # *Website URLContact PersonTitleAre you an individual, partnership or corporation?Please select oneIndividualPartnershipCorporationState of CorporationS-Corp or C-CorpPlease select oneS-CorpC-CorpCorporate Officers *PARTNER INFORMATIONPartner Information: Addresses, Emails, Telephone *BUSINESS INFORMATIONSales Tax Status *Taxable *Exempt (if exempt, attach Exemption Certificate to this form)Choose FileNo file chosenDelete uploaded fileDoes your Company use Purchase Orders? (Yes or No) *YesNoHow much credit do you require for this account? *A/P Contact Name *Email Address *Email where invoices should be sent *Specify, by full name and title if any, those employees who are either authorized to charge purchases or specify purchase order requirements.CREDIT INFORMATIONBank Name *Checking Account # *Supplier / Commercial References (3 minimum required) Name, Email, Phone, Contact Person *Have you, or any corporation of which you were an office or director, or a partnership of which your were a member ever filed for bankruptcy? (Yes or No) *YesNoIf yes, please list date, state and name of entityTERMS OF CREDITThe Debtor / Applicant states that it has disclosed the above information for the purpose of obtaining credit and it warrants that it is true. Any misrepresentation as to the information requested shall be grounds for denial of credit or immediate revocation of credit. In consideration of any extension of credit by Breaker King and Electrical Supply, I / We agree to the terms of sale, returns policy and the following terms of credit: Breaker King and Electrical Supply terms are net 30 days. Breaker King and Electrical Supply, will access a service charge of 1.5% per month, 18% per annum, on all balances over 30 days past due. Breaker King and Electrical Supply, elects to place any outstanding sums in the hands of an agency or attorney for collection, in addition to Court costs and sheriff’s fees, a collection fee of 33 1/3% will be added to the balance due whether or not legal action is instituted. The Debtor / Applicant shall provide whatever additional personal guarantees Breaker King and Electrical Supply deems necessary, and shall execute the guaranty included below. The Debtor / Applicant authorizes any credit investigation needed for action on this application. The Debtor also agrees that accounts receivable information may be reported by Breaker King and Electrical Supply to various credit agencies. GUARANTY(To be completed by all Applicants unless otherwise instructed by Breaker King and Electrical Supply) In consideration of Breaker King and Electrical Supply extending credit to the Debtor / Applicant, the undersigned personally and conditionally guarantees payment to Breaker King and Electrical Supply of all amounts owed by the Debtor / Applicant to Breaker King and Electrical Supply and any payments which may become due to Breaker King and Electrical Supply in the future. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the business of the Debtor / Applicant, including indebtedness arising out of successive transactions that either continue the indebtedness or from time to time renew it after it has been satisfied. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal agreement of the credit agreement hereby guaranteed. The undersigned shall also be liable for all attorney fees, interest and other collection costs incurred by Breaker King and Electrical Supply in its attempt to collect from the Debtor / Applicant or to enforce this guaranty. This guaranty shall also attach to and follow any assignment or reassignment of the accounts assigned pursuant hereto. This guaranty shall be binding upon the executor or personal representative, and successors and assigns of the undersigned. Signature *Right click and drag to signYour browser does not support e-Signature field.Submit