| Wasem Packaging & Crating Service 2591 Harrison Road Columbus, Ohio 43204 Ph: (614) 279-6413 Fax: (614) 279-2736 Credit Application Business Name:________________________________________________ Address:______________________________________________________ City:_________________________________________________________ State or Province:____________________________________________ Zip or Postal Code:____________________________________ Country:_____________________________________________________ How many years at address:______________________ Email:_____________________________________ Phone #:_______________________________________ Fax #:_________________________________________ D/B/A: Federal Tax ID # or SS #:_______________________________ OWNERSHIP: Sole Owner / Partnership / Corporation Principal (name) (title) :_______________________________________________ Principal (name) (title) :_______________________________________________ Buyer: Sales Manager:______________________________Phone #_____________________ Accts Payables:______________________________Phone #______________________ Purchase Orders Required?_____________________ TRADE REFERENCES (Name, Address, Phone/Fax number and Account Number) PHONE AND FAX # REQUIRED 1. Name:___________________________________________________________ Address:(street)__________________________________________ ( City, State, Zip )_________________________________________ Phone:______________________________ Fax:_________________________________ Account#: __________________________________ 2. Name: __________________________________________________________ Address:(street )_________________________________________ ( city, state, zip )__________________________________________ Phone: _______________________________ Fax: _________________________________ Account#: __________________________________ 3. Name: ________________________________________________________ Address:(street )_______________________________________ ( city, state, zip )________________________________________ Phone: _____________________________ Fax: _______________________________ Account#: ________________________________ BANK REFERENCE (name)(address)(acct#) (phone/fax#) Checking Loan Savings Phone or Fax # Required Name: ___________________________________________ Address (Street ): ______________________________ ( city, state, zip )_______________________________ Account#: _____________________________________ Phone: ______________________________ Fax: ________________________________ BANK REFERENCE 2 (name)(address)(acct#) (phone/fax#) Checking Loan Savings Phone or Fax # Required Name: ______________________________________________ Address (Street): _________________________________ (city, state, zip)____________________________________ Account#: _____________________________________ Phone: ____________________________________ Fax: ________________________________ I hereby authorize my bank to release any information needed on account# to Wasem Packaging & Crating Service (Name)____________________________________________________ (Title)_________________________________(date)_______________ Number of Employees:__________ Est. Annual Sales $ _______________________ If No you do have a website, please list ALL websites you Sell on or plan to sell on:(If you do not have a website enter none) Website:_____________________________________________ _____________________________________________ Has your company or any of its Principals ever filed bankruptcy? ________________ If yes, Explain:___________________________________________________________ ______________________________________________________________________ Do you want an email confirmation with tracking information when your order ships? Yes / No Any misrepresentation in this application will be considered evidence of fraud, since This information is the basis for granting credit. As an inducement to grant credit, The undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit reference listed. You have read the terms page listed on our web site and here by agree. (Name)___________________________________________ (Title)__________________________________ (Date) ______________________ Personal Guarantee In consideration of credit being extended by Wasem Packaging & Crating Service, to the above named applicant for merchandise be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantors each hereby contract and guarantee to Wasem Packaging & Crating Service the faithful payment, when due, of all accounts of said applicant for the purchases made after the date of this application. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by: (Your name) _____________________________________________, Any extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Absent written permission by creditor, this personal guarantee may not be revoked. The undersigned guarantor or guarantors, hereby agree to pay 1.5% interest rate per month for any balance outstanding within (30) days of billing. The undersigned guarantor or guarantors hereby agree to pay reasonable attorney’s fees; in addition, court costs for any unpaid balance within (90) days of the date of billing. You have read the terms page listed on our web site and here by agree. (Signature)_______________________________ (title)________________________ (Drivers License #)________________________ |