|
Company name:
|
Date of application: |
|
|
Indicate one: ❑
Partnership ❑
Sole Owner
❑
Non-Profit
❑
Corporation |
|
|
Articles of Incorporation Reg. Number: |
State of: |
|
|
Type of business: |
|
|
Services rendered / products sold: |
|
|
|
|
|
Current Company Address |
Previous Address |
|
|
Street: |
Street: |
|
|
City, State, Zip: |
City, State, Zip: |
|
|
Telephone: |
|
|
|
Number of years at current address: |
Number of years at previous address: |
|
|
|
|
|
Do you hold the lease on the building in which business is located?
If no, please complete information on lease holder: |
|
|
Lease holder name: |
|
|
Lease holder address: |
|
|
Lease holder telephone: |
|
|
|
|
|
Name of Subsidiary / Parent company: |
|
|
Affiliation: |
|
|
Address: |
|
|
Telephone: |
|
|
Contact Title: |
|
|
|
|
|
Have you previously applied for credit with Ultimate Epoxy? |
If yes, when? |
|
|
Under what business name? |
|
|
Brief description of the service requested from Ultimate: (Floor
service, Asphaltic Materials, Service Equipment)
|
|
|
Approximate monthly charge: |
|
|
|
|
|
|
|
|
|
REFERENCES |
|
1. Bank Reference: |
Branch: |
|
Type of Account: |
Account number: |
|
|
|
2. Bank Reference: |
Branch: |
|
Type of Account: |
Account number: |
|
|
|
Please list two business references below. (Please use street
address, not post office box.) |
|
1. Company name: |
Telephone: |
|
Address: |
|
|
|
2. Company name: |
Telephone: |
|
Address: |
|
|
|
PRINCIPALS OF YOUR COMPANY |
|
Name: |
Position: |
SS#: |
|
Home address: |
|
Previous address: |
|
I certify that I am the person named above. As principal of
_______________________________ I authorize Ultimate Epoxy, its
employees, agents or representatives to review my own personal
credit profile to be used only in conjunction with this application
for company credit. |
|
Signature: |
|
|
|
Name: |
Position: |
SS#: |
|
Home address: |
|
Previous address: |
|
I certify that I am the person named above. As principal of
_______________________________ I authorize Ultimate Epoxy, its
employees, agents and representatives to review my own personal
credit profile to be used only in conjunction with this application
for company credit. |
|
Signature: |
|
|
|
Payments must be received by Ultimate Epoxy on or before the due
date. In case of default in payments, Ultimate Epoxy has the
following rights and remedies, in addition to all other rights
permitted by law:
-
To assess late fees and/or
interest, further to assess mechanical lien on real property where
service performed
-
To submit the debt to a
collection agency or our Collection Department, without prior
notice, for collection and/or litigation
-
The client agrees to pay all
costs of collection, including reasonable attorney’s fees
This and any agreement entered with Ultimate Epoxy shall be governed
by the laws of the State of Michigan. |
|
Signature indicates that the company agrees to the above terms as
listed. Signature also certifies that information provided by
applicant is accurate. |
|
Signature of owner or officer: |
Date: |