Name and address of your resident agent
PARTNERSHIP
Names and addresses of the partners

SOLE PROPRIETORSHIP
Are you sales tax exempt? Yes No Resale number: #__________________
Have you ever had credit with us before? Yes No
If yes, under what name?

Authorized purchasers:
*

Purchase order required?
Yes No

TRADE REFERENCES
Reference #1
Name: *
Address:
Phone: Fax:

Reference #2
Name: *
Address:
Phone: Fax:

Reference #3
Name:
Address:
Phone: Fax:

BANK REFERENCES
Bank#1
Account # *
Phone: Fax:
Contact person:
Name of bank:
Address:

Bank#2
Account #
Phone: Fax:
Contact person:
Name of bank:
Address:

I represent that the above information is true and is given to induce JOHN HOWARD COMPANY, INC. to extend credit to the applicant. My company and I authorize JOHN HOWARD COMPANY, INC. to make such credit investigation as it sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to John Howard Company, Inc. any and all information concerning the financial and credit history of my company and myself.I have read the terms and conditions stated below and agree to all of these terms and conditions.

Printed name: *
Title: * Date: *

GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE
1. TERMS ARE NET 30 DAYS SUBJECT TO ESTABLISHED CREDIT LIMIT.

2. A SERVICE CHARGE OF 1.5% PER MONTH WILL BE ADDED TO ALL AMOUNTS BILLED IF NOT PAID WITHIN THIRTY DAYS.

3. NO ADDITIONAL CREDIT WILL BE EXTENDED TO PAST DUE ACCOUNTS UNLESS SATISFACTORY ARRANGEMENTS ARE MADE WITH OUR CREDIT DEPARTMENT.

4. ALL COSTS OF COLLECTION INCLUDING REASONABLE ATTORNEY’S FEES WILL BE ADDED SHOULD LEGAL ACTION BE REQUIRED TO COLLECT ANY BALANCE OWED.

5. PERSONAL GUARANTEE: IF THE CREDIT CUSTOMER IS A CORPORATION, THEN THOSE SIGNING THIS APPLICATION, WHETHER SIGNING AS AN OFFICER OR NOT, PERSONALLY GUARANTEE PAYMENT FOR ALL ITEMS PURCHASED ON CREDIT BY THE CORPORATION.