BRYANT CREDIT APPLICATION APPLICATION FOR CREDIT PLEASE CHECK PRIMARY LOCATION YOU ARE APPLYING FOR. YOUR CUSTOMER NUMBER WILL BE GOOD AT ANY OF OUR WAREHOUSES. Lowell Charlotte Hickory Laurinburg Rock Hill Company Information County: Business Name: Telephone No. Fax No. Street Address: PO Box: City: State: Zip: Billing Address: PO Box: City: State: Zip: Type of Business: How Long In Business: Owners and/or Officers 1. 2. Do you require a statement? Do you issue Purchase Orders? Where do you bank? Account Number: Business is a: (Check appropriate category) Partnership Corporation Individual Individual Partnership Under the laws of the state of SIC No. If Individual: Social Security Number: Employed by: Contractors License: Drivers License Number: State : Spouse Name: Employed by: Social Security #: PLEASE FURNISH US WITH THREE BUSINESS REFERENCES: Name 1. 2. 3. Address: City & State: Telephone: Estimated amount of credit required: $ (MUST BE COMPLETED) IF PURCHASES ARE TAX EXEMPT, PLEASE ATTACH SIGNED TAX CERTIFICATE FOR OUR FILES I hereby authorize Bryant Electric Supply, Inc. to conduct a complete check of my credit history and bank experience. I agree to pay applicable service charges and any legal expenses incurred in the collection of this account. Further, the undersigned individual who is either a principal of the credit application or a sole proprietorship of the credit application, recognizing that his or her individual credit history may factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report (s) on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process. Do you AGREE to the above terms? Yes No Signed: PLEASE COMPLETE ALL THE QUESTIONS ON THIS FORM, PRINT A COPY, SIGN WHERE INDICATED AND MAIL A HARD COPY TO: BRYANT ELECTRIC SUPPLY, INC. ATTENTION: CREDIT MANAGER PO BOX 1000 LOWELL, NORTH CAROLINA 28098-1000 Please attach a copy of your latest financial statement. Personal Guarantee In order to induce Bryant Electric Supply Company, Inc., to extend credit to Company at this address I hereby guarantee the payment of any account due or to become due by said company to Bryant Electric Supply Company, Inc., including attorney's fees incurred, if any, for the collection of such amount. This guarantee shall include past due balances, current balances, and future sales and credit hereafter extended and fees hereafter incurred. This guarantee shall remain in full force and effect until revoked in writing by registered mail--return receipt. Revocation of this guarantee does not relieve obligation to pay balances owed whether past due or current and whether or not for same has been made. Executed at: City and State, this day of , (year) . Individually and as Guarantor Individually and as Guarantor
APPLICATION FOR CREDIT
PLEASE CHECK PRIMARY LOCATION YOU ARE APPLYING FOR. YOUR CUSTOMER NUMBER WILL BE GOOD AT ANY OF OUR WAREHOUSES.
Lowell Charlotte Hickory Laurinburg Rock Hill
Company Information
County: Business Name: Telephone No. Fax No. Street Address: PO Box: City: State: Zip: Billing Address: PO Box: City: State: Zip: Type of Business: How Long In Business: Owners and/or Officers 1. 2. Do you require a statement? Do you issue Purchase Orders? Where do you bank? Account Number: Business is a: (Check appropriate category) Partnership Corporation Individual Individual Partnership Under the laws of the state of SIC No. If Individual: Social Security Number: Employed by: Contractors License: Drivers License Number: State : Spouse Name: Employed by: Social Security #:
PLEASE FURNISH US WITH THREE BUSINESS REFERENCES: Name 1. 2. 3. Address: City & State: Telephone: Estimated amount of credit required: $ (MUST BE COMPLETED)
IF PURCHASES ARE TAX EXEMPT, PLEASE ATTACH SIGNED TAX CERTIFICATE FOR OUR FILES I hereby authorize Bryant Electric Supply, Inc. to conduct a complete check of my credit history and bank experience. I agree to pay applicable service charges and any legal expenses incurred in the collection of this account. Further, the undersigned individual who is either a principal of the credit application or a sole proprietorship of the credit application, recognizing that his or her individual credit history may factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report (s) on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.
Do you AGREE to the above terms? Yes No Signed: PLEASE COMPLETE ALL THE QUESTIONS ON THIS FORM, PRINT A COPY, SIGN WHERE INDICATED AND MAIL A HARD COPY TO: BRYANT ELECTRIC SUPPLY, INC. ATTENTION: CREDIT MANAGER PO BOX 1000 LOWELL, NORTH CAROLINA 28098-1000
Please attach a copy of your latest financial statement.
Personal Guarantee
In order to induce Bryant Electric Supply Company, Inc., to extend credit to Company at this address I hereby guarantee the payment of any account due or to become due by said company to Bryant Electric Supply Company, Inc., including attorney's fees incurred, if any, for the collection of such amount. This guarantee shall include past due balances, current balances, and future sales and credit hereafter extended and fees hereafter incurred. This guarantee shall remain in full force and effect until revoked in writing by registered mail--return receipt. Revocation of this guarantee does not relieve obligation to pay balances owed whether past due or current and whether or not for same has been made. Executed at: City and State, this day of , (year) . Individually and as Guarantor Individually and as Guarantor
Branches
