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The following information is
provided for the purpose of my (our) obtaining Commercial Credit
now and hereafter from The Steel Yard. The Steel Yard is
authorized to contact my (our) references for the purpose of
exchanging information related to this application and are held
nameless without incurring any liability |
| Company
Name: |
|
| Phone
Number: |
|
| Fax Number: |
|
| Billing
Address: |
|
| City,
State, Zip |
|
| E-mail, Website |
|
| Shipping
Address: |
|
| Tax I.D. # |
|
| Tax Exempt
# (Include copy of resale
certificate) |
|
| Accounts
Payable Contact: |
|
| Phone # |
|
| Number of
Years in Business: |
|
| Years at
present location |
|
| Type of
business |
|
| If Branch
(Home Office) |
|
| Phone # |
|
| Address |
|
| City, State,
Zip |
|
| Pick one of
the following: |
Bankruptcy
Filed |
| State of
Incorporation |
|
|
|
|
Personal
information on ownership: If partnership, include all partners, if
corporation include all officers
|
| Name,
Position |
|
| SS#, Drivers
License # |
|
| Name,
Position |
|
| SS#, Drivers
License # |
|
| Name,
Position |
|
| SS#, Drivers
License # |
|
|
|
|
Bank
Reference |
| Bank Name
& Branch |
|
| Account No: |
|
| Address: |
|
| Bank Phone
Number: |
|
|
Trade
Reference |
| Name: |
|
| Phone #:
(required) |
|
| Fax #:
(required) |
|
| Name: |
|
| Phone #:
(required) |
|
| Fax #:
(required) |
|
| Name: |
|
| Phone #:
(required) |
|
| Fax #:
(required) |
|
| Name: |
|
| Phone #:
(required) |
|
| Fax #:
(required) |
|
| Name: |
|
| Phone #:
(required) |
|
| Fax #:
(required) |
|
|
|
| Purchase
Order Required |
Job
Reference Required |
|
Persons
authorized to purchase on account |
| Name (s) |
|
|
The above statement has been carefully read and all representation
is correct and true. THE STEEL YARD, INC. terms are Net 30
days from date of invoice. Amount past due will be placed on
credit hold with C.O.D. status until current. An additional 2%
service charge (or the maximum permitted by applicable state law)
may be charged to all accounts not paid
within 30 days after due date and similarly, each month thereafter
until paid. In any action to collect my (our) debt I hereby agree
to pay all cost and expenses including attorney’s fees, collection
agency fees, and court
costs at the pretrial and appellate levels. |
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