PLEASE ANSWER ALL QUESTIONS
Company Name
Partnership
Proprietorship
Corporation
If Corporation, State & Year Incorporated
Date Corporation Established
Federal ID#
Type of Business
Phone #
Fax #
E-mail
Street Address
City
State
Zip
How Long at This Address
Mailing Address
City
State
Zip
Does Company Own Real Property?
No
Address
Do you pledge, factor or borrow accounts receivable:
No
From Whom
Special Billing Instructions
Amount of Credit Requested
Normal Payment Cycle
LIST ALL BANK ACCOUNTS AND INFORMATION
Name
Acct. Num.
City
State
Type of Acct
Contact
Phone Num.
Name
Acct. Num.
City
State
Type of Acct
Contact
Phone Num.
Signature to authorize
x___________________________________
Title:
LIST ALL PRINCIPALS OF COMPANY WITH THEIR TITLES
Name:
Title:
SS#:
Home Address:
City:
State:
Zip:
Own:
Name:
Title:
SS#:
Home Address:
City:
State:
Zip:
Own:
Name:
Title:
SS#:
Home Address:
City:
State:
Zip:
Own:
COMPANY SUPPLIERS / REFERENCES
Name:
City:
State:
Phone Number
Contact:
Name:
City:
State:
Phone Number
Contact:
Name:
City:
State:
Phone Number
Contact:
CREDIT AGREEMENT
In consideration of the credit to be extended to me under this agreement, I/We herewith agree to pay all invoices within the agreed to terms of NET 15 Days; that in the event of default on any invoice Cal State Xpress shall have the right to declare all invoices due and payable at once; that in the event legal action is instituted to enforce collection, to pay reasonable attorney's fees and costs for such legal action. In the event of a dispute or Litigation between the parties, it is hereby agreed that Jurisdiction and Venue shall be in Los Angeles County, California. I/We authorize Cal State Xpress to run credit reports and/or confirm the information in this credit application. I/We further agree to the terms and conditions contained within the tariffs of Cal State Xpress and on the Cal State Xpress invoice. I/We further authorize my/our bank to release general information to Cal State Xpress if they so request. I further declare that I have the authority to apply for credit on behalf of the above named entity. That upon payment in full of any invoices, this agreement will remain in effect and will apply to any and all invoices thereafter.
Name of Business:
Date:
Signature:
x___________________________________
Print Name & Title:
PERSONAL GUARANTEE
The undersigned agrees to act as a personal guarantor and co-signer to this agreement for all debts incurred both now and in the future for all monies owned by the Company, Organization, Persons, or Corporations who have signed this credit application and who have been extended credit both now and in the future. Guarantor recognizes, understands and agrees that this guarantee cannot be revoked or rescinded if any balance remains owed and outstanding to Cal State Xpress and Guarantor hereby waives their subrogation or recovery rights.
Guarantor:
x___________________________________
Signature Must be Owner, Partner, or Officer
Guarantor:
x___________________________________
Signature Must be Owner, Partner, or Officer
Signature: Witness/Agent of Cal State Xpress :
x___________________________________
Date:
Application for Credit to be Printed, Signed and Faxed to
