Credit Profile Form

Tri-County Business Systems

Credit Application

Terms of Sale: Net Thirty Days -1.5% finance charge on all accounts Thirty-One plus days past due.

Corporation/Business Information:
Full Name: ____________________________ Federal Tax No. __________________

Address: ______________________________ Phone No. ______________________

City: __________________________________ State: _____ Zip Code: ___________

Type of organization: ϨSole Owner   ϨPartnership   ϨCorporation

How long in business: yrs. Years at present address yrs. ______________________

Previous Address: ______________________________________________________

Owner or Manager’s Name: ________________________ Phone No. _____________

Address: ______________________________________________________________

Corporate officers or majority partners name: ________________________________

Address: __________________________________ Phone No. __________________

Title: ________________________________ Type of Business: _________________

Bank References:
Name of Bank: ________________ Branch: __________ Phone No. _____________

Type of Account: ________________________________ Account No. ___________

Local Suppliers:
Company: _____________________________________ Phone No. _____________

Address: _____________________________________________________________

Company: _____________________________________ Phone No. _____________

Address: _____________________________________________________________

For Billing Purposes:

Do you require a copy of invoices to support purchases?  ϨYes ϨNo
If billing address is different from above, please enter your correct address below:
_____________________________________________
_____________________________________________
_____________________________________________

Terms of sale: an invoice accompanies each purchase made in the store or sent via delivery. Please remit payment from this invoice as no statement will be rendered. Thank you.

All bill are due and payable within thirty (30) days. A finance charge of 1.5% per month will be added automatically to all accounts over thirty one days past due.

Any account with a balance over 60 days will be put on a c.o.d. only basis until all of the old balance is paid in full.

For the purpose of obtaining merchandise from you on credit the above statement as to the information involving the corporation or business, _____________________, is made in writing and it is correct as of this date.

In addition, the terms of sale explanation has been read and understood and will be adhered to if credit is extended to this corporation or business.

Date: ___________________ Signature & Title: __________________________