Credit Application
For Credit Approval:
Email to: Fax to: (781) 871-5686
general Information
Business Name:
DBA: / Website:
Phone: / Fax: / E-mail:
Address: / State of Incorporation:
City: / State: / ZIP Code:
Date started: / Federal ID#: / DUNS#:
Sole proprietorship: / Partnership: / Corporation: / Other:
Check here if business is Tax Exempt: / Tax Exempt#: / You must provide a copy of your tax exempt certificate.
Bank and Credit Information
Bank name: / Contact Name:
Bank address: / Phone: / Fax:
City: / State: / ZIP Code:
Type of account: / Account number:
Savings
Checking
Other(Specify)
trade references (*must provide three*)
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account: / Current Balance: / Contact Name:
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account: / Current Balance: / Contact Name:
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account: / Current Balance: / Contact Name:
company contact information
Accounts Payable Contact Name: / Accounts Payable Phone:
Accounts Payable Email: / Accounts Payable Fax:
AGREEMENT ACKNOWLEDGEMENT
This application is submitted to Signet Electronic Systems, Inc. (“Signet”) by Applicant (“Applicant”) to obtain trade credit. Upon acceptance, this agreement will become binding between Signet Electronic Systems, Inc. and Applicant. Applicant hereby certifies that the above information is complete and accurate and Applicant has the authority to apply for credit on behalf of the herein named business. Signet will have therefore entered into this agreement in reliance on the information submitted by Applicant in this application. Consent is hereby given for the foregoing information on Applicant to be verified or inquired upon either directly or indirectly. Such inquiry may be made through a credit reporting agency, from time to time as needed.
Applicant agrees to make payment in full to Signet for all amounts due according to Signet’s invoices. All transactions with Signet Electronic Systems, Inc. are subject to Signet’s standard payment termsof net 30 and where otherwise stated, the applicable contract documents’ terms and conditions. A finance charge at the maximum legal rate of 1.5% per month may be assessed on past due invoices. Should Applicant default in any such payment(s), Signet shall have the right, without notice to the Applicant, to declare all invoice amounts due and payable. In the event that Signet should commence any action or actions, or otherwise seek to enforce this agreement against Applicant, Applicant agrees to pay reasonable attorney’s fees, court costs and other expenses incurred by Signet, whether suit is filed or not. All disputes shall be resolved in the Commonwealth of Massachusetts and are subject to the laws within this jurisdiction. This agreement is strictly confidential and is not transferable or assignable without the prior written consent of Signet Electronic Systems, Inc. No act or omission of Signet will be deemed to constitute a waiver of any of its rights absent an express, written statement to that effect. Applicant agrees that any changes in liability for any debts incurred to Signet Electronic Systems, Inc. due to change in Applicant’s form of business or ownership shall not be effective as to Signet until such time that Signet receives actual notice of the change by certified mail.
Authorized Signature
Signature of Officer/Owner:______
Print Name:
Title:
Date:
Credit Application 2010-2.doc