Legal business name __________________________ Date ______________
FEIN ____-__________
Doing business as (DBA) _____________________________________
Street Address _________________ City _____________________ State __________ Zip
_________
Business Phone __________ Fax _____________ Email______________________________
Billing Address _____________________ City _______________ State
___________Zip________
Accounts Payable Contact Name ____________________ Direct Phone_________________
Year established _______________ Status of business (circle one)
Individual Partnership
Corporation LLC
If incorporated, in what state __________________ Year of incorporation
______________
Name of parent company if subsidiary____________________________________________
Parent Company Address ________________________City ______________ State
____ Zip _______
Do you have, or have you had, any judgments, garnishments, or bankruptcies Yes
_____ No _____
If yes, please explain
______________________________________________________________________________
Owners, corporate officers, or managers of LLP/LLC
1. Name _______________________________ Title ____________________
SSN ________-_________-_________
Address ________________________
City ______________ State _______ Zip __________
Home phone _________________ Cell phone _______________
Own or rent home ___________ Time @ present address _________________
2. Name _______________________________ Title ____________________
SSN ________-_________-_________
Address _________________________ City
_____________ State ________Zip __________
Home phone _________________ Cell phone _______________
Own or rent home ___________ Time @ present address _________________
Bank Reference ______________________________ Phone ________________________
Address ___________________________ City
______________ State _______ Zip ___________
Officer in charge of your account __________________
Checking account #
_____________________
Trade References:
1. Supplier ______________________________ Phone __________________ Fax
___________
Contact name __________________________________
Account # ______________________
2. Supplier ______________________________ Phone __________________ Fax
____________
Contact name __________________________________
Account # ______________________
3. Supplier ______________________________ Phone __________________ Fax
_____________
Contact name __________________________________
Account # ______________________
Is there a current financial statement available for your business?
Yes _____ No _____
If yes, is this statement audited? Yes
_____ No _____
Will you be
willing to furnish a copy of this financial statement?
Yes _____ No _____
If yes,
please furnish the most recent copy of your financial statement.
Open credit line amount request $____________
Applicant's signature warrants (a) ability and willingness to pay invoices in
accordance with Nixcavating, Inc. (hereinafter "seller")
standard terms (b) agreement to pay a service charge of up to2% per month (24%
annual percentage rate) or maximum rate applicable by law added on past due
accounts (c) agreement to pay all reasonable costs of collection, including a
reasonable sum for attorney fees if the account is not paid when due (d)
a faxed copy of this credit application is considered the original. (e) the
undersigned has full power and authority to execute this credit application on
behalf of applicant (f) seller may resort to any security it or they may
have in order to satisfy any dept with seller withstanding any collateral
or security agreement seller shall also retain all rights of set off against
any equity, assets, security credits due or accounts of or with
customer seller rights are cumulative and not alternative (g) customer
shall send seller written notice of any changes in the form of or the
ownership of the customer's business within five days after any change (h) all
financial statements provided to seller are true and correct and
applicant agrees go provide updated financial statements to sellers upon any
of their reasonable requests.
Applicant's signature warrants that for purposes of determining the venue for
bringing any legal action on the account that the account is payable at
Nixcavating, Inc., 1821 Boston Avenue, Longmont CO 80501.
Signature of
owner/principal or authorized officer/partner
____________________________________________________
Everything
stated in this application is true and correct and accurately describes my
(our) financial condition as of the date signed to the best of my
knowledge. Seller Nixcavating,
Inc. is authorized to obtain such information as required to evaluate the
credit worthiness and financial responsibility of the customer any principal
of and any guarantor for this customer.
Nixcavating, Inc. is authorized to conduct a complete credit review
including obtaining a credit report and making inquiry of all creditors
listed on the application or creditors discovered through whatever source and
to release all such information to any party which may provide credit to
applicant. Nixcavating, Inc. is
also authorized to review my account from time to time and to obtain any
credit information needed for the purposes of collection. By signing below, express authority is given to
creditors to release any information request by Nixcavating, Inc. Customer agrees that this application will remain
Nixcavating, Inc. property whether or not credit is granted.
Company Name __________________________
1. Signature _______________________________ Date ______________
Printed name and title ________________________________________
2. Signature _______________________________ Date ______________
Printed name and title ________________________________________
PERSONAL GUARANTY
KNOW ALL MEN BY THESE PRESENTS, That I, we, and each
of us, stockholders, directors, officers, officers or
otherwise
interested in ___________________________________ herein after referred to as
"debtor" do hereby request that
Nixcavating, Inc. extend credit to or otherwise do business with said
debtor or renew of extend any obligation of or forbear
for any period of time the strict enforcement of any obligation to the
above named debtor.
To
induce Nixcavating, Inc. to do so, and in consideration thereof and of
benefits to accrue to each of us there from, each of us as primary
obligor jointly and severally and unconditionally guarantees unto Nixcavating,
Inc. that said debtor will fully, promptly and faithfully perform, pay and
discharges all of debtor's present and future obligations to Nixcavating,
Inc. and agrees without Nixcavating, Inc. first having to proceed against
said debtor to liquidate any evidence of indebtedness or security
therefore, to pay Nixcavating, Inc. of demand all sums due and to become due to
Nixcavating, Inc. from said debtor and all losses, costs, attorney's fees, or
expenses which Nixcavating, Inc. may suffer by reason of debtor's default.
Each
of the undersigned hereby subordinates any sums now or hereafter due to him
from debtor to the payment of any sums now or hereafter-due Nixcavating,
Inc. from debtor.
This
guaranty may be terminated only by notice sent to Nixcavating, Inc. at its
place of business in Boulder County, Colorado, by registered mail,
stating an effective date after the receipt of such notice by
Nixcavating, Inc., but shall continue thereafter as to each of us who has not
given such notice, and shall continue as to each of us giving such notice
with respect to any transaction with and any obligation of the debtor
incurred prior to date of termination. No
termination shall be affected by the death of any of us.
Each of us waives notice of the acceptance hereof and of presentment,
demand, protest, and notice of nonpayment or protest as to any note or
obligation signed, accepted, endorsed, or assigned by debtor to
Nixcavating, Inc. Renewal, extension
or transfer of any obligations or security therefore shall not affect the
obligation of any of us hereunder.
Agreement
that for purposes of determining the venue for bringing any legal action on
the account, that the account is payable at Nixcavating, Inc. 1821 Boston
Avenue, Longmont CO and any such action that may be brought in Boulder
County at the election of Nixcavating, Inc.
This Guaranty shall bind our respective heirs,
administrators, personal representatives, successors and assigns.
All rights of Nixcavating, Inc. shall be considered as cumulative.
1. Signature _________________________________
Printed name ______________________________
Social security # ___________________________
Address ___________________________________
City, state, zip code __________________________________
2. Signature _________________________________
Printed name ______________________________
Social security # ___________________________
Address __________________________________
City, state, zip code __________________________________
Subscribed before me the _______ day of ___________________, 20____.
My commission expires _______________
Notary Public ____________________________________
Notary Public ____________________________________
