ZeoFill Incorporated PHONE: 888-926-4785
9241 Seventh Ave Fax: 702-988-8796
Hesperia, CA 92345 Email: sales@zeofill.com
Legal Name of Applicant: Last: First: Middle Initial:
Legal Name of Business: DBA:
Address: Ship to Address:
street/city (street/city/state
state/prov/zip prov/zip)
If same; Print SAME
Phone Number: Ship to Phone Number:
Fax Number: Ship to Contact Name:
Type of Business:
FEDERAL ID#:
State/Prov Business is Registered: Estimated Yearly Purchase: Years in Business:
Sales Queries Contact: E-mail:
Account Queries Contact: E-mail:
Dunn & Bradstreet # How to get a D&B number click here
Bank Reference:
Bank Name: Contact: Phone Number:
Bank Address: Checking Account #:
(street/city/state
prov/zip) Savings Account #:
Trade References:
(1) Name: Address:
Phone Number: Fax Number: E-mail:
(2) Name: Address:
Phone Number: Fax Number: E-mail:
(3) Name: Address:
Phone Number: Fax Number: E-mail:
THE USE OF MY CORPORATE TITLE IS ONLY TO IDENTIFY MY POSITION IN THE COMPANY AND IN NO WAY NEGATES MY PERSONAL GUARANTEE
ZeoFill Incorporated PHONE: 888-926-4785
9241 Seventh Ave Fax: 702-988-8796
Hesperia, CA 92345 Email: sales@zeofill.com
Personal Guarantor Acknowledgement:
I, personal guarantor of the Applicant, acknowledge and agree that the above information is true and correct and if ZeoFill Inc. approves the Applicant’s application for the Account, I will be jointly and severally liable for any and all unpaid amounts that the Applicant may owe ZeoFill Inc. under the terms of the Credit Card Agreement (“CCA”). To determine creditworthiness, I authorize ZeoFill Inc. to obtain and investigate my personal credit bureau report and financial records, including any bank accounts held jointly or individually in my name. I agree to personally guarantee payment of any and all debt arising under or pursuant to the CCA, including as permitted under applicable law, reasonable attorney’s fees, arbitration fees, court fees, and/or collection costs. I agree that ZeoFill Inc. can enforce this guarantee without first proceeding against the Applicant or any other guarantor(s) until such time all amounts due and owing have been paid in full. ZeoFill Inc. may send notices and correspondence regarding the Account to Applicant and I will consider them received. I agree to guarantee payment even if the terms of the CCA have been changed. I understand that any negative information, including delinquency, may be reported to the appropriate credit reporting agency. I further understand and agree that other information regarding this account including, but not limited to, payment history, write-off amounts and my status as guarantor on the Account may be communicated to the credit bureaus. I further agree that all past due balances will be subject to a 2% per month 24% per year service charge.
Applicant understands and agrees that, subject to applicable law, the content of this application and any other information submitted to ZeoFill Inc. may be shared with and retained by ZeoFill Inc. in connection with ZeoFill Inc. Business Credit program.
Applicant: Title: *
Home Address:
Social Security #:
Date of Birth:
Signature: Date:
Co-Applicant: Title:*
Home Address:
Social Security #: Date of Birth:
Signature: Date:
*If corporate guarantor, authorized officer must sign and show corporate title. If partnership guarantor, both general partners must sign and show "Partner" as Title. If individual guarantor, must sign and show "Individual" as Title.
Name of Authorized Purchasers on this account:
Name: E-mail:
Name: E-mail:
Name: E-mail:
Completely fill out entire two forms. Then print forms, sign and fax back to 1-702-988-8796 (Press the submit button afterwards)
Personal Guarantee must be signed in order to receive credit terms on product including shipping cost and more than one truckload of product in a given Net Term time frame.
(Page 1 Contiued)
TO PRINT FORMS Press (Ctrl + P) (Page 2) Fax form back at: 1-702-988-8796
(Print forms, sign and fax back)
(Print forms, sign and fax back)
WE REPORT TO DUNN & BRADSTREET
Has the firm or any of it's principals ever been Bankrupt? [__] Yes [__] No
If Yes, explain__________________________________________________________________________________________________
Any misrepresentation in this application will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principals listed.
In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed of Net [___] and agrees to pay a service charge per month of 1-1/2% per month (18% annual percentage rate) on all past due balances. In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs of not more than 33.3%, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred.
The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.
________________________________________________
(Name of Business)
____________________________________ _________________________ ________________________________________________
(Print Name) (Title) (Signature)
____________________________________ ___________________________ ________________________________________________
(Print Name) (Title) (Signature)
