Application for Credit

(Please Print this form, fill out, and FAX to (214) 351-6076)

Name of Company: _______________________________
Physical Address: _______________________________
Billing Address (if different): _______________________________
How Long at Above Address: _______________________________
How Long in Business: _______________________________
Business Phone: _______________________________
FAX: _______________________________

 Note: We FAX invoices.  Please advise if different FAX # should by used for this purpose only.

   Type of Business:
Partnership Individual Corporation
Date Incorporated: ______________________________
Owner/Officer: __________________

Title:

__________________________
Home Address: _____________________________________________________
Home Telephone: ___________________

Social Security:

___-__-____
Credit/Business References: (Include Name, Address, Phone, FAX, and Contact)

  1.  _______________________________________________________________________________

  2.  _______________________________________________________________________________

  3.  _______________________________________________________________________________

  4.  _______________________________________________________________________________

Bank Reference:
Name: ______________________________________________
Address: ______________________________________________
Phone: _______________
Account Number: ______________________________________________
Officer Name: ______________________________________________

Terms of Sale:  1% 10 days or net 10th prox. eighteen percent (18%) per annum charged on all past due accounts.  In consideration of the extension of credit to the above named business or corporation, I/we, the undersigned do hereby accept all terms and conditions of sale, authorize the investigation of credit history, and do hereby guarantee the prompt payment of all invoices and charges for the above named business or corporation.  This guarantee shall continue until written notice of cancellation signed by me/us is received, but shall not affect my liability as debts then owing.  I/we also agree to pay reasonable attorney and collection fees should it become necessary to place the above named account for collection and agree that this contract is performable in Dallas County, Texas and waive the right of suit elsewhere.

Agreed to this_______Day of _________________in the year ______________________
Signature: __________________________________________________
Printed Name: __________________________________________________
Choice of Terms: 1% - 10  Net 10th Prox.
Sales Tax Status: Taxable  Purchases for Resale

 

(Must Furnish Tax Exempt Certificate)

Phone (214) 357-7317 || Toll free (800) 442-3396 || Fax (214) 351-6076
2425 Burbank St.   Dallas, TX   75235
www.jordanredwood.com