1. Business Name _________________________________________________________________
2. Permanent Address ______________________________________________________________

(Street Address) (City) (State) (Zip)

3. Mailing Address_________________________________________________________________

(Street /Box) (City) (State) (Zip)

4. Phone #(____)_____-_______ Ext#_____ Fax # (____)____-______ email _________________
5. Ownership check one; O- Sole Owner O- Partnership O- Corporation
6. Federal Identification # ____________________________ Social Security # ____-___-_____
7. Principals/Corp. Officers __________________________________________________________

(Name) (Home address) (Title)

__________________________________________________________

(Name) (Home address) (Title)

8. Length of time in Business Years_____________ Months _________________

9. Tax Exempt #_______________________________ Please attach copy of Certificate

10. Is this business affiliated or part of another business that is not a Customer? If so give details:

11. Trade References:

Name Street City State Zip Phone# Fax#

(1)________________________________________________________________________________

(2)________________________________________________________________________________

(3)________________________________________________________________________________

12. Bank References:

Name Street City State Zip Phone# Fax#

(1a)_______________________________________________________________________________

Contact Account# Checking/Savings

(1b)_______________________________________________________________________________

Name Street City State Zip Phone# Fax#

(2a)_______________________________________________________________________________

Contact Account# Checking/Savings

(2b)_______________________________________________________________________________

13. Anticipated Monthly Credit ________________________________________________________
14. Accounts Payable Contact _________________________________________________________

 

15. In making this application for credit, I authorize you to make an investigative report whereby information is obtained through credit reporting agencies.
16. In consideration of Hansen's Locksmithing extension of credit to___________________________ hereinafter designated as "Applicant", I ________________________, hereby unconditionally guarantee to Hansen's Locksmithing the full and prompt payment by applicant of all bills due by the terms and conditions listed below to Hansen's Locksmithing upon receipt of invoice/bill. If at any time default shall be made by the applicant in the full and prompt payment of bills due, I shall thereupon pay said bill and shall be fully responsible and liable as guarantor for said payment. ______________________________________________________________

All prices are subject to change without notice, and are not guaranteed. Invoice terms are net 30 days from the date of the invoice. If your business is Tax-Exempt, we need to have on file a state resale Certificate (Tax Number) or otherwise be subject to Nebraska State Sales Tax and City Tax where applicable.

All Shipments are F.O.B. Alliance, NE 69301.

Orders over $250.00 will be ½ Prepaid prior to order (account have had too many companies claiming Bankruptcy). If any special billing requirements are needed Customer must provide all information needed for proper billing. Hansen's Locksmithing is not responsible for inaccurate or inadequate information. If reprocessing of claim occurs, applicant is responsible for any and all fees (including late charges or postage).

Any defects or errors, for which we are responsible, will be promptly rectified. Approval for returns of merchandise must be requested of us. A minimum of 25% restocking charge for stock items will be issued on all returns accepted for reasons other than defects or our error. No returns will be allowed on special ordered or non-stock merchandise.

We reserve the right to hold or refuse orders from customers whose accounts are over 30 days past due, until the past due portion of the account (including the Finance Charge) is cleared up and the account becomes current.

Invoices may be paid in full within 30 days after the invoice date without a finance charge. Optional terms for payment (if any) will be indicated on the individual invoice, applying to that invoice only.

A periodic rate or minimum charge of $5.00 computes finance Charges. A periodic rate of 2% per month will be charged after deducting current payments and/or Credits. All Payments will first apply t outstanding finance charges and then to purchases. All payments will be by invoice. Statements are sent to customers upon Request only a $2.00 charge will apply for postage and processing. Purchaser is liable for all legal cost if this account is placed for collection.

I have read and understand the terms and conditions as written and I agree with them and this contract with Hansen's Locksmithing.

Signed ________________________________________ Date _____________________________