Credit Application And Payment And Guarantee Agreement printable pdf download

CREDIT APPLICATION AND PAYMENT AND GUARANTEE AGREEMENT

To induce Century Distributors, Inc. to sell merchandise or extend credit to Purchaser or accept business

checks from Purchaser, Purchaser and Guarantor must complete and sign this Application and Agreement. All

sales are C.O.D. until Century agrees to extend credit to Purchaser. Only company officers of Century are

authorized to negotiate and agree to credit terms. All sales are subject to the terms stated herein.

Purchaser’s Legal Name:____________________________________________________________________________

Purchaser’s Trade Name (if different from legal name)_____________________________________________________

Purchaser’s Address:_________________________________City/State______________________Zip

Billing Address (if different)____________________________City/State______________________Zip

Business Tel:_____________________Fax:_________________________ Email Address:________________________

Business Type (check one): ( ) Corporation ( ) Individual/Sole Proprietor ( ) Limited Liability Company (LLC)

( ) Partnership ( ) Non-Profit ( ) Limited Liability Partnership (LLP) ( ) Limited Partnership

( ) Government Agency ( ) Professional Association (PA) ( ) Professional Corporation (PC)

Cigarette Lic. No.____________________ Sales Tax No._____________________ Tax Exempt No. ________________

Employer Identification No. (FEIN):_________________________ Certificate of Resale Attached? ( ) Yes ( ) No

Credit Terms Requested: _____________________P.O. Required?( )Yes ( ) No Date Business Started:

PURCHASER’S OFFICERS/OWNERS/GENERAL PARTNERS/MANAGING AGENTS/PRINCIPALS/INDIVIDUALS

Name ____________________________________ Title ______________________ Home Phone

Home Address___________________________________Birth Date______________Soc. Sec. #

Name ____________________________________ Title ______________________ Home Phone

Home Address___________________________________Birth Date_____________ Soc. Sec. #

Name ____________________________________Title ______________________ Home Phone

Home Address___________________________________Birth Date_____________ Soc. Sec. # ___________________

FINANCIAL AND BANKING INFORMATION:

Purchaser’s Bank (business checks):_____________________________________Check Acct # ______________________________

Purchaser’s Bank (other accts: savings; lottery; payroll, etc.)________________________ Acct #’s ____________________________

Guarantor’s Personal Bank: Checking Acct. _____________________________ Other Accts _________________________________

Has Purchaser ever filed bankruptcy ( ) Yes ( ) No; Has Guarantor ever filed bankruptcy? ( ) Yes ( ) No. If “yes” to either, provide:

Date Filed: __________ Court Name & Location _____________________________________________________________________

Case#_________________________ Reason for Filing:

TRADE /CREDIT REFERENCES:

Name: ____________________ Address:____________________ Contact: ____________________ Tel:____________

If business is less than one (1) year old, provide the name, address, telephone # and account # for Guarantor’s residential

landlord or mortgage company: _______________________________________________________________________

_________________________________________________________________________________________________

THIS IS A TWO SIDED DOCUMENT

Review the important payment, guaranty and other terms on the reverse side and sign

Please submit copy of Business License

Credit Application And Payment And Guarantee Agreement