**FAILURE TO ANSWER ALL QUESTIONS MAY RESULT IN SHIPPING DELAYS**
CREDIT APPLICATION / CREDIT AGREEMENT / GUARANTY Full Legal Business Name & D/B/A Business Address Fax Number
Phone Number
At this address?
How long in business? Tax Exempt?
No
UBI/TAX ID # ; Own Lease Concession
Yes – Tax Exempt No.
(mark one)
(Must provide Exemption Certificate)
Does Company own real property? If yes, give address Does Individual own real property? If yes, give address Spouse:
A) SOLE PROPRIETORSHIP? Owner’s Name:
Owner’s Soc. Sec. #
Owner’s home address
B) PARTNERSHIP? List all partners and provide information below: (use back of form if more space is needed) 1. Name:
SSN:
Address:
2. Name:
SSN:
Address:
C) CORPORATION? List all officers and provide information below: 1. President:
SSN:
Address:
2. Vice Pres:
SSN:
Address:
3. Sec/Treas:
SSN:
Address: Contact
Bank Reference: Bank Name
Phone
Savings Acct No.
Checking Acct No. Trade Reference: a)
b)
c)
Phone/Contact:
a)
b)
c)
Fax Number:
a)
b)
c)
TERMS OF AGREEMENT This agreement shall apply to future credit (if any) and all existing indebtedness owed by undersigned to Alack Refrigeration Co., Inc. or its subsidiaries. Alack Refrigeration Co., Inc. Is authorized to inquire of our bank and trade references, and to obtain our personal credit report to evaluate and update our credit worthiness. We agree to abide by the credit terms of Alack Refrigeration Co., Inc. as established and amended from time to time. If we do not comply with those terms we agree to pay interest at 18% per annum, plus all collection and attorney fees actually incurred. If a lawsuit is commenced we agree to venue in Hammond, Tangipahoa Parish, Louisiana at the option of Alack Refrigeration Co., Inc., and waive the right to litigate outside Tangipahoa Parish. If we sell, transfer or change the ownership or legal structure of our business we agree to provide written notice thereof delivered to the credit department of Alack Refrigeration Co., Inc., which notice must actually be received. Until we provide such notice we agree to pay for all purchases made on the account(s) established in our name. All purchases shall be for business purposes only. A fax copy of this document may serve as the original.
By: (Proprietor/Partner/Corp. Officer)
(Date)
The undersigned, having a financial or other interest in the applicant business, does unconditionally, personally, and individually guarantee payment of all amounts owed Alack Refrigeration Co., Inc. by the above named business, including interest, costs, and attorney fees, and attorney fees incurred in enforcing this guaranty. I/We specifically agree to the provisions set forth above, including venue. This guaranty shall be continuing and may not be canceled except by written notice actually received by the credit department of Alack Refrigeration Co., Inc. This guaranty is personal to the signer. Any notation of corporate or agency capacity is informational only and shall not effect the personal nature of the guaranty. In the event Alack Refrigeration Co., Inc. retains the services of an attorney or collection agency to enforce this guaranty the undersigned agree to pay all attorney/agency fees.
(Guarantor)
(Date)
(Guarantor)
2136 Reading Road y Cincinnati, OH 45202 Phone: (513) 421-4700 y Fax: (513) 639-4090
(Date)