328 Limerock Pit
14850 West Hwy 328
Ocala, FL 34482
CREDIT APPLICATION
Date: ______
Company Name: ______
Billing Address: ______
Shipping Address: ______
City: ______State: ______Zip: ______
Phone: ______Fax: ______
Date Business Formed or Incorporated? ______
Type of Business: ______
This Business is a: Sole Proprietorship □ Partnership □ Corporation □
Federal Tax ID No. ______Amount of Credit Required $______
Are you Exempt from Sales Tax? ______If yes, please attach a copy of your exemption Certificate.
11810 NW 115th Avenue • Reddick, FL • 32686
Phone: (352) 840-0161 • Fax: (352) 867-1859
Have you ever purchased from Commercial Industrial Corporation or its subsidiaries in the past ______
If yes, under what name? ______
LIST PARTNERS/PRINCIPALS:
NAME: ______TITLE: ______SS # ______
Address ______Phone ______
NAME: ______TITLE: ______SS # ______
Address ______Phone ______
BANK REFERENCE:
Name: ______Acct. No. ______
Address: ______City ______State ______Zip ______
Contact Person ______Phone # ______
Business Credit References
Name / Phone # / Fax #Address / City / State / Zip
Name / Phone # / Fax #
Address / City / State / Zip
Name / Phone # / Fax #
Address / City / State / Zip
BILLING REQUIREMENTS:
Purchase Order Required / Accounts Payable Contact / Phone # / Fax # / Other Special Requirements.YES NO
TERMS AND CONDITIONS: It is understood credit terms are NET 30 from invoice date. Amounts past due are subject to a service charge of 18%. In consideration for extending credit to the above named customer, under the specified terms, the undersigned hereby unconditionally, jointly and severally, personally guarantee payment for all goods ordered in the above name, and grants permission to check personal credit history. By signing below, the applicant agrees to pay CIC’s invoices in accordance with CIC’s Credit and Payment Terms. The information provided on this credit application is for the purpose of obtaining credit and is warranted to be true.
Personal Guarantee
In consideration of credit being extended by Commercial Industrial Corp., to the above named applicant for merchandise purchased whether applicant be an individual, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor(s) each hereby contract and guarantee to Commercial Industrial Corp., the faithful payment when due, of all accounts of said applicant for purchases made after the date of this application. The undersigned guarantor(s) each hereby expressly waive all notice of acceptance of the guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor(s) of dishonor or default by applicant or with respect to any security held by Commercial Industrial Corp., extension to time of payment to applicant, acceptance to partial payment or partial compromise, all others notices to which the undersigned guarantor(s) might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to Commercial Industrial Corp., 11850 NW 115th Ave Reddick, FL 32686
.
Guarantor Signature ______Title: ______
Guarantor Print Name: ______SSN# ______
Guarantor Signature ______Title: ______
Guarantor Print Name: ______SSN# ______
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11810 NW 115th Avenue • Reddick, FL • 32686
Phone: (352) 840-0161 • Fax: (352) 867-1859