“Setting the Standard since 1990”
CREDIT APPLICATION
Instructions: Fill out as completely as possible. Items marked with a ¨ MUST be completed in order to process the application. If you have any questions, please call Accounts Receivable at 210-509-3334.
¨Type of Term applying for:
( ) COD Company Check ( ) COD Cash ( ) Others______
( ) Credit Card – ( ) VISA ( ) MasterCard
Requesting $______Credit Line at NET ( ) 30 days ( ) 45 days (approval required)
Referred by: ______Xenco Sales Manager: ______
¨Company Name: ______Contact: ______Phone (_____)______Fax__(_____)______
Billing Address: ______
______
City State Zip
Type of Business: ( ) Corporation ( ) Partnership ( ) Proprietorship
Established in (M/Yr.)____/_____ ¨Federal Tax I.D.#______
¨Do you require purchase orders? ( )Yes ( )No
¨Bank References:
Name______Contact______Tel:______
Address______Fax:______
Account#______Email:______
¨Trade References: (Major Suppliers, Verifiable Contacts Only) FAX # Required
Name______Contact______Tel:______
Fax:______Type of Business:______
Address______Account#______
Name______Contact______Tel:______
Fax:______Type of Business:______
Address______Account#______
Name______Contact______Tel:______
Fax:______Type of Business:______
Address______Account#______
¨By signing this agreement, I/We authorize the release of credit and bank information to XENCO Laboratories by references listed above.
Signature______Date______
Print Name______Title______
CREDIT APPLICATION
How long at billing address_____Yr_____Mo ( )Own ( )Rent
Controller’s Name______
*Name of Accounts Payable Contact______
*Email ______
*REQUIRED*
Principles of Company:
1.Name______Social Security#______
Home Address______
2.Name______Social Security#______
Home Address______
3.Name______Social Security#______
Home Address______
INDIVIDUAL PERSONAL GUARANTY
I______, residing at______for and
In consideration of your extending credit at my request to ______
______(hereinafter referred to as the “Company”), hereby personally guarantee the payment to XENCO Laboratories of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever the company shall fail to pay the same. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the Company. I do hereby waive notice of default, nonpayment and notice hereof and consent to any modification of renewal of the credit agreement hereby guaranteed.
Print Name______
Guarantor Signature______
Date______,20______
Return ASAP to the XENCO via fax (210-509-3335) or email at Thank you for interest in Xenco Laboratories. We look forward to doing business with you.
Credit Department
P.O. Box 2256
Stafford, Texas 77497
PRIVACY RELEASE
I/We have made application to Xenco Laboratories to be established as a client for the analytical services they provide on an open account basis.
In this regard, I/We authorize the firm to investigate the references submitted pertaining to My/Our credit and financial responsibility.
COMPANY: ______
Address: ______
City, State: ______
Phone Number: ______
Authorized Signature: ______
Date: ______
Please return this form with your credit application.