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Company Information

Date

Phone Number

DBA or Assumed Name

Legal Business Name

Billing Address

Shipping Address

Accounts Payable Contact Name

Accounts Payable Contact Email Address

Accounts Payable Contact Phone Number

Do you prefer invoices to be mailed or emailed? Do you prefer invoices to be mailed or emailed?MailedEmailed

How long at current address?

Federal Tax ID#

Former Business Address (if applicable)

Resale #

New Field

Type of Business

Date Business Established

Does State, County, or City require a License? Does State, County, or City require a License? Yes No

Ownership Ownership Sole Proprietorship Partnership Corporation

Principal

Name and Title

SS#/Drivers License#

Name and Title

SS#/Drivers License#

Name and Title

SS#/Drivers License#

Trade References

Name

Address & Email Address of Contact

Name

Address & Email Address of Contact

Name

Address & Email Address of Contact

Bank References

Institution Name

Address/Phone

Contact Name

Account #

Routing #

Number of Employees

Estimated Annual Sales

Sales Area

Has the firm or any of its principals ever been Bankrupt? Has the firm or any of its principals ever been Bankrupt? Yes No

If yes, please 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. Payment Terms are NET 30 days In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed 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, 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. 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. Payment Terms are NET 30 days In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed 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, 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

Name/Title

Signature

Name of Business

Signature

Personal Guarantee

In consideration for Consolidated Parts extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Consolidated Parts by the business identified below whether said sums are due under open account, contract or otherwise. It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Consolidated Parts and the business. The undersigned individual shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Consolidated Parts. The guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Consolidated Parts. Said notice shall specify the date on which this guaranty is to be terminated; said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination. In consideration for Consolidated Parts extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Consolidated Parts by the business identified below whether said sums are due under open account, contract or otherwise. It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Consolidated Parts and the business. The undersigned individual shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Consolidated Parts. The guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Consolidated Parts. Said notice shall specify the date on which this guaranty is to be terminated; said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.

Name of person guaranteeing payment, NO TITLE

Home Phone

Social Security Number

Signature of person guaranteeing payment

Date

Name of business whose account is guaranteed