APPLICATION FOR CREDIT 519 Nolana Ave, Mcallen, Texas 78504 | WWW.RgvOptics.com
PURE OPTICS
Phone: 855.882.1336 Fax: 855.573.2253 EMAIL TO RGVOPTICS@GMAIL.COM
COMPANY INFORMATION -Have you had an account with RGV Optics before?
Company Name
No
Yes
(If yes, provide previous acct. # ___________
Years In Business
D.B.A
Name(s) of Principal Owner(s) City
Shipping Address Billing Address
Zip
State
City
State
Zip
Phone #
Phone # A/P Contact & Phone #
I would like my monthly statement emailed to: Ownership:
Sole Proprietor
Corporation
Partnership
SSI#
Federal ID#
SSI#
Are you TAX EXEMPT?
No
Tax ID #
Yes (if yes, please provide an exemption certificate)
BANK REFERENCE Bank Name
City
Contact ______________________________
State
Checking Account #
Zip
Phone #
_
CREDIT LIMIT REQUESTED $ TRADE REFERENCES (Please provide comparable trade references whom you do business with) [1] Acct. # Ph. # Fax #
____________________ ____________________ ____________________ ____________________
[2] Acct. # Ph. # Fax #
[3] Acct. # Ph. # Fax #
____________________ ____________________ ____________________ ____________________
____________________ ____________________ ____________________ ____________________
AUTHORIZATION TO OBTAIN CREDIT INFORMATION
The undersigned authorizes Rgv Optics and / or its related entities to obtain credit information from the above listed references, the bank, and from any credit reporting agency. Signature:
PERSONAL GUARANTEE
Date
[Please specify: Owner, Partners, or Corporate Office]
The undersigned does hereby absolutely, unconditionally and personally guarantee to RgvOptics, the payments of all indebtedness and obligations of whatever nature to Rgv Optics as they come to be due, whether such indebtedness and obligations exist on the date of this instrument or are incurred after such date.The obligations hereunder shall be binding on the heirs, administrators, successors and assigns of the undersigned. If the account becomes delinquent and is placed for collection the undersigned agrees to pay any and all collection fees and if court action becomes needed, further agrees to pay attorney fees, court costs and related travel expenses. Venue for any litigation shall occur in McAllen, Texas, Hidalgo county - Home Office of Hersteller Optiks and Rgv Optics. Guarantor (Print Name) Home Address
FOR OFFICE USE ONLY
SSN# City
Guarantor Signature State
A
D
RL
Zip
Home Phone #
ACL
CT