Credit Application

TERMS AND CONDITIONS

Please read carefully before submitting.

The applicant would like to establish credit facilities with DaCorta Hardware.

In consideration of DaCorta Hardware granting credit, applicant declares and agrees as follows:

o The applicant represents that the information given in this application is complete, accurate and true in all respects.

o The applicant will promptly advise DaCorta Hardware in writing of any proposed or inherent changes to the applicant entity.

o The account terms will be Net 30 days unless otherwise specified.

o All invoices will be paid within 30 days from the invoice date. A finance charge of 1.5% per month will be due on any past due balance.

o Applicant will be responsible for any expenses, costs or disbursement incurred by DaCorta Hardware in recovering any outstanding balance including attorney costs and debt collection agency fees.

o DaCorta Hardware cannot be held responsible for any unauthorized purchases made by any associate of the applicant. To minimize this risk, we recommend the use of purchase orders.

Submitting this form certifies that applicant has read, understands and agrees to the above statements.

Company Name

Title

Date

Legal Business Name

Federal Tax ID#

DBA

Mailing Address

City

Select a State

Zip Code#

Phone#

Fax#

Years in Business

Type of Business

Contact for Sales

Contact for Account Payable

Ownership

Are Purchase Orders Required

Names of Authorized Purchasers

If tax exempt, please attach copy of resale certificate or letter of exemption to application

Credit Limit Requested

Bank Name

Account Number

Branch

Trade Reference (1)

Phone Number

Contact

Trade Reference (2)

Phone Number

Contact

Name

Social Security #

Drivers License

Date of Birth

Home Address

City

State

Zip Code

Home Phone Number

Cell Phone Number


Credit Application