Credit Application for a Business Account

Credit Application for a Business Account

Rick Boucher, Inc. DBA: EQUIPRO Business Phone: 817-834-5800 Business Fax: 817-834-5803
Business Information
Business name:
Mailing address:
City: / State: / Zip:
Physical address:
City: / State: / Zip:
Business Phone: / Business Fax: / E-mail:
Sole proprietorship: / Partnership: / Corporation: / Federal ID #:
Nature of Business: / Years in Business:
No. of Employees: / Purchase Order Required? YES NO
A/P Contact name: / A/P Contact number:
Do you have any special requirements or restrictions on who may use your account?
Principal Owners or Officers
Full name: / Title:
Home Address:
City: / State: / Zip:
Home Phone: / Social Security:
Full name: / Title:
Home Address:
City: / State: / Zip:
Home Phone: / Social Security:
Bank Information
Bank: / Address:
Phone: / Fax:
Account No. / Contact:
Business trade References
Company name: / Account type:
Address:
City: / State: / Zip:
Phone: / Fax:
Company name: / Account type:
Address:
City: / State: / Zip:
Phone: / Fax:
Company name: / Account type:
Address:
City: / State: / Zip:
Phone: / Fax:
terms of credit Agreement
All invoices are to be paid within 10 days from the date of the invoice. All amounts not paid when due shall accrue interest at the lesser of: 1 1/2% per month, or the highest rate permitted by applicable law. Customer shall be responsible for and agrees to pay all costs, fees, and expenses (including, but not limited to attorneys’ fees) incurred by EQUIPRO in enforcing these terms or collecting amounts due. Claims arising from invoices must be made within seven working days. By submitting this application, you authorize EQUIPRO to make inquiries into the banking and business/trade references that you have supplied. The undersigned warrants that all information listed on this application is correct, has read, accepted and agrees to be personally bound by all stated terms and conditions set forth herein and in each agreement entered into by the undersigned or the agents of the undersigned.
Print Name:______Title:______
Signature:______Date:______