Credit Application

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Credit Application
Thank you for your interest in a Credit Account with Interior Supply Inc. Please fill out the below application to the best of your abilities. We will review your information and follow up for any additional documentation needed. We look forward to hearing from you!
Name Of Business*
Business Tax ID*
Address*
Phone*
City*
State*
Zip Code*
Cell Phone
Pager
Fax
Email*
Nature Of Business*
Date Established*
MM slash DD slash YYYY
Accounts Payable Manager*
Receive Invoices By
- Fax
- Email
Do you already have a sales contact?*
- Yes
- No
If so, who?
Business Structure
Business Structure
- Corporation
- Partnership
- Sole Proprietorship
Is this a home-based business?
- Yes
- No
Company Principals in Charge of Business Activity

Principal

First Name	Last Name	Position	Home Address	Phone Number	City	State	Zip Code	Drivers License Number	Social Security Number	% Of Ownership
											Edit Delete
There are no Principals.

Bank Reference
Name Of Bank
Branch Location
Branch Address
Branch Phone
City
State
Zip Code
Checking Account Number
Savings Account Number
Loan Balance
Type of Loan
Secured By
Loan Officer Name
Trade References

Trade References

Company Name	Account Number	Address	Phone Number	City	State	Zip Code
							Edit Delete
There are no Trade References.

*NOTE: Please enter at least 3 references.

Statement of Data Accuracy and Release of Authority to Verify
The undersigned, for the purpose of procuring and establishing credit from time to time with Interior Supply, Inc. hereafter referred to as Supplier and to induce Supplier to permit the undersigned Customer to become indebted to Supplier for the purchase of goods, materials, and/or services, furnishes the above business and personal credit information. The undersigned, (jointly and individually, if applicable) certify that all information in this Credit Application is complete, factual and correct, and understands that Supplier will rely on the accuracy of this information for any credit that may be extended. If any statement is not true in any material respect or if the Customer should file for bankruptcy or if any other creditor tries to seize the Customer’s property or if any adverse change occurs in the Customer’s financial condition, at the Supplier’s election, you may declare all of my indebtedness and obligations to you immediately due and payable without demand or notice. The undersigned hereby expressly authorizes Supplier to contact any parties listed by Customer herein for the purpose of verifying any information contained in this Credit Application. The undersigned hereby waives any right of privacy which it may have in any such information, and waives the effect and benefit of any statutes or regulations which give it the right to control or bar the releases of such credit information. Further, the undersigned hereby authorizes such parties to disclose to Supplier whatever information they may have with respect to the undersigned’s credit or financial status and hereby agree to hold such parties harmless for any such disclosure. If any representations made in this Credit Application are untrue, the undersigned agrees that all obligations of the Customer to, or held by, Supplier shall immediately become due and payable without demand or notice. The undersigned hereby acknowledges receipt of a copy of this Credit Application.
Signature
Signed*
Date*
MM slash DD slash YYYY
Personal Guaranty
As an inducement to you to grant credit, or assume a credit risk, from time to time, in respect of sales of goods, supplies or services made by you to:
Company Name*
hereinafter referred to as the “Customer” or in respect to any other type of transaction by which you may become the creditor of the Customer, the undersigned shall pay to you promptly when due, or upon demand thereafter without deduction for any claim of setoff or counterclaim of the Customer or loss of contribution from any co-guarantor, or any other defense, the full amount of all obligations or indebtedness due to you from the Customer, including interest, whether originating in transactions between you and the Customer, or assigned or transferred to you, together with all expenses of collection and/or reasonable counsel fees incurred by you by reason of the default of the Customer. This is a continuing guaranty, and shall be revocable only as to transactions entered into by you subsequent to the receipt by one of your officers of notice of termination sent by the undersigned by registered or certified mail. The undersigned waives notice of acceptance hereof, and notice of orders, sales, and deliveries to the Customer, and of the amounts and terms thereof, and of all defaults or disputes with the Customer, and of the settlement or adjustment of such defaults or disputes. The undersigned, without affecting his liability hereunder in any respect, consents to and waives notice of all changes of terms, the withdrawal or extension of credit or time to pay, the release of the whole or any part of the indebtedness, the settlement or compromise of differences, the acceptance or release of security, the acceptance of notes, trade acceptances or any other form of obligation for the Customer’s indebtedness, and the demand, protest, and notice of protest of such instruments or their endorsements. The undersigned also consents to and waives notice of any arrangements or settlements made in or out of court in the event of receivership, liquidation, readjustment, bankruptcy, reorganization, arrangement, or assignment for the benefit of creditors of the Customer, and anything whatsoever, whether or not herein specified, which may be done or waived by or between you and the Customer, or the Customer and any other person whose claims against the Customer have been or shall be assigned or transferred to you. The obligation of the undersigned is a primary or unconditional obligation, and covers all existing and future indebtedness of the Customer to you. This obligation shall be enforceable before or after proceeding against the Customer against any security held by you, and shall be effective regardless of the solvency or insolvency of the Customer at any time, the extension or modification of the indebtedness of the Customer by operation of law, or the subsequent incorporation, reorganization, merger, or consolidation of the Customer or any other change in the composition, nature, personnel, or location of the Customer. All liabilities of the Customer and of the undersigned shall mature immediately upon the insolvency of the Customer, the inability of the Customer to meet its obligations as they become due, the appointment of a receiver, custodian or trustee for the Customer or any of its property, the filing of a voluntary or involuntary petition for relief in bankruptcy, reorganization or arrangement, the making of an assignment for the benefit of creditors, or the calling of a meeting of creditors by the Customer or if any of the foregoing events shall occur with respect to the undersigned. Nothing herein contained shall be construed as an obligation on your part to sell goods or extend credit to the Customer or as an obligation to continue to sell goods or extend credit. Your records showing the account between you and the Customer shall be admissible in evidence in any action or proceeding involving this guaranty, and such records shall be prima facie proof of the items therein set forth. This guaranty shall for all purposes be deemed to be made in, and shall be governed by, the laws of the State of Ohio, Pennsylvania and Indiana.
Personal Guarantor Signature*
Typed Name*
Home Address*
City*
State*
Zip Code*
Attachment To Credit Application
Taxable?*
- Taxable
- Non-Taxable
If non-taxable, you must include a copy of your blanket exemption form with this application. Individual exemption forms must be filed on each job, only if certain jobs are tax-exempt
Blanket Exemption Form*
Accepted file types: doc, docx, pdf, Max. file size: 300 MB.
Do you require a purchase order?*
- Yes
- No
Please list names of those authorized to purchase on the account.*
Supply Agreement
CREDIT APPLICATION submitted to INTERIOR SUPPLY INC. on the following date, and by the following customer.
Date*
MM slash DD slash YYYY
Customer Name*
Terms & Conditions
TERMS
Unpaid invoices are past due 30 days from date of invoice.

LATE PAYMENT
Past due accounts are subject to a late charge of one and one-half percent (1 1/2%) on the amount overdue.

BAD CHECKS, C.O.D.
A service charge of $20.00 will be applied to each returned check. If at any time, Customer fails to pay invoices when due, or if for any reason Supplier feels insecure in extending credit, Supplier may decline to provide further goods on credit.

FAILURE TO PAY OR INSOLVENCY
Failure by Customer to pay any part of the account when due, or in the event that proceedings in bankruptcy, receivership, or insolvency are instituted by or against Customer or his property, Supplier may at his option, cause the entire unpaid balance to become due immediately payable and Supplier shall have the right to enter at anytime without notice upon the premises where any of the materials procured by the Customer from Supplier are located. Customer hereby expressly waives any right to action which may accrue by reason of the entry for taking possession of or the selling of with respect thereto including service charges and reasonable attorney’s fees and court costs. Customer will be liable for all costs of collection, including but not limited to attorney’s fees, if necessary

ADDITIONAL SECURITY FOR PAYMENT
The Customer hereby agrees to execute such additional documents as the Supplier may require including a personal and/or business guaranty and UCC Financing Statements as required from time to time by the Supplier.

ENTIRE AGREEMENT
This Agreement covers all materials which the Customer may hereafter acquire at any time from Supplier. This Contract constitutes the entire agreement with Supplier. No waivers or modifications shall be valid unless the same are in writing and executed by the parties hereto. This contract shall apply and accrue to the benefit of, and be binding upon, the heirs, executors, administrators, successors, and assigns of the respective parties.

RECEIPT OF A COPY
Customer hereby acknowledges the receipt of a copy of the Agreement at the time of its execution.
Acceptance By Customer
Signature*
Typed Name*
Position*
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.