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Application for Credit

[Click for Printable Version]

Business Name:
Street Address:
City:
State:
Zip Code:
Telephone:
Fax:
Email:
Type of Business:
Date Established:
Type of Ownership: Corporation
Sole Proprietorship
Partnership
Other
Taxpayer's Federal ID Number (9 digits):  - 
(If you are Tax Exempt, please forward a copy of your Tax Exempt Certificate
signed by an officer of the company)
Owner's Name:
Officer:
Title:
Accounts Payable Contact:
Phone:
Bank Name:
Bank Address:
Phone:
Fax:
Account Number:
Credit References (3)
1. Name:
Account Number:
Street Address:
City, State, Zip:
Phone:
Fax:
2. Name:
Account Number:
Street Address:
City, State, Zip:
Phone:
Fax:
3. Name:
Account Number:
Street Address:
City, State, Zip:
Phone:
Fax:
Amount of Credit Requested $:
Purchase Order Required? Yes      No
Credit Policy for Charge Accounts

Upon approval of this application, it is agreed that all purchases will be paid in full and in accordance with the terms of sale as stated on RnD Products invoices.

If I/We do not pay RnD Products according to terms, it is understood that accredit privileges may be withdrawn, deliveries held, and 1.33% per month service charge will be added to your past due balance.  If RnD Products finds it necessary to obtain assistance in collecting any past due balance, I/We agree to pay reasonable attorney fees, collection fees, and/or court costs allowable by law.

If a check is returned to RnD Products by the Customer's bank for non-sufficient funds, a charge of $21.00 will be issued to the Customer.  The Customer is required to replace the NSF check plus the $21.00 charge with cash, money order, or certified check.

The above information as stated on the three mentioned pages, is warranted to be true in support of this application.  RnD Products is hereby authorized to obtain credit and/or financial information from my/our bank and other financial institutions or commercial firms with whom I/We have done business.  It is understood that any such credit and/or financial information will be held in strict confidence and used only in consideration of this application.  I/We have read and fully understand the above credit policy.

Company Name:
By:
Title:
Date:
By:
Title:
Date:

Please print an original copy with officer's signatures to finalize the application process.

Please enter the verification code in the field below.
Note that this code is CAsE SeNSiTiVE.