HomeMy WebLinkAboutAgreement_General_04/10/2014 100OBulbs.com
2140 Merritt Dr. — GARLAND, TX 75041
Sales Account Manager: Zachary Simpson PHONE: 972 - 535 -0896 —FAX: 972 -535 -0897
CREDIT APPLICATION AND PAYMENT AGREEMENT
"The following information is provided by applicant to 1000Bulbs.com for the purpose of obtaining
credit for purchases of material and services"
COMPANY NAME: U I j (.lam f l on i 1
r
STREET ADDRESS: ( (,� BILLING:
CITY: ( tke STATE: ZIP: 334(09
P.O. BOX NUM R: BILLING:
CITY: STATE: ZIP:
NAME: - tk '(11 MLEPHONE: %(_7(9
MAILING ADDRESS: 13 ewi EM& BILLING:
CITY: STATE: L ZIP: 3 - 3 Y bq
* * ** *NOTE: PLEASE INDICATE WHICH ADDRESS ABOVE IS TO BE USED FOR BILLING * * **
TELEPHONE: %k - C� - 070C) FAX: �� ��( — 676 8E -MAIL: , rvl corkle� .o rW
/ (IF NONTAXABLE, PLEASE ATTACH A TEXAS R E CERTIFICATE AN J
TAXABLE: (YES) (NO) (/ SUBMIT IT ALONG WITH THIS AGREEMENT)
NAME AND TITLE OF PERSON SUPPLYING INFORMATION: Dahtt 0 4 ru
�imi n �O�SSi sue•
NAME, TITLE AND TELEPHONE OF PERSON TO CONTACT ON CREDIT AND FINANCIAL MATTERS:
TYPE OF BUSINESS: CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP
IF INCORPORATED, PLEASE PROVIDE THE NAMES OF COMPANY OFFICERS:
PRESIDENT:
VICE PRESIDENT:
SECRETARY/TREASURER:
IF COMPANY IS PARTNERSHIP OR SOLE PROPRIETORSHIP, PLEASE PROVIDE THE FOLLOWING
INFORMATION ON EACH OF THE PARTNERS AND /OR PROPRIETORS:
NAME:
STREET:
CITY: STATE: ZIP:
SOCIAL SECURITY NO.: DRIVERS LICENSE NO.:
TELEPHONE: FAX:
2
NAME:
STREET:
CITY: STATE: ZIP:
SOCIAL SECURITY NO.: DRIVERS LICENSE NO.:
TELEPHONE: FAX:
LENGTH OF TIME IN BUSINESS: 5 t (I Ce
ESTIMATED MONTHLY PURCHASES FROM I000Bulbs.com:
PURCHASE ORDER NUMBERS REQUIRED: (YES) (NO): ✓
TRADE AND BANKING REFERENCES
COMPANY NAME ADDRESS TELEPHONE &
II �y FAX #
2 `AA COQ
4)
BANK NAME: Yl� ArmMi i
ADDRESS: ' t,.)r ��/ 1 (YI • - r� (�Fp> 1 L 3 3y 0
OFFICER HANDELING ACCOUNT: v
TELEPHONE: � I- p 32 - aa45
Credit Application
Applicant agrees to pay for all purchases from 1000Bulbs.com in accordance with the
credit terms as follows:
1. Terms are Net 30, due 30 days after date of invoice.
3
2. Applicant agrees that it is responsible for payment of all purchases made
by the applicant and the applicant's employees. In the event payment is not
timely made, interest will accrue at the highest rate allowed by law on all
past due amounts. Applicant also agrees to pay all costs and expenses
associated with collection of the account, including but not limited to,
reasonable attorney's fees in the event the account is placed with an attorney
for collection or suit. Applicant agrees to pay all amounts due and owing
for purchases at the offices of 1000Bulbs.com in Garland, Dallas County,
Texas.
Agreed to and accepted by:
(Company Officer, Partner or Proprietor)
Print Name: . ✓� t��
Title: t "` L
Date: ►
........................................ ...............................
PERSONAL GUARANTE
I personally guarantee the payment of all debts in �edto00Bulbs.com- in'behalf of
the applicant company, In t�vent that
payment for said debts are turned over r collection or presented for payment in a
court of law, payment will be ma pon presentation of un aid invoices with
certifi/ nt a public accountant certified in the State of Texas.
Agreey: (vidually)
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