CMA Supply Company, Incorporated     

 

3201 Roosevelt Ave       3333 Independence Dr     1900 Watterson Tr         9984 Commerce Park Dr      910 W. Ireland Rd             5000 Angola Rd

Indianapolis, IN  46218    Fort Wayne, IN  46808    Louisville, KY  40299    Cincinnati, OH  45246          South Bend, IN  46614      Toledo, OH  43615

317-545-4446                 260-471-9000                  502-499-2221                 513-942-6663                      574-231-9000                    419-776-9000

FAX 317-545-5631         FAX 260-471-4720         FAX 502-499-2241         FAX 513-942-7546              FAX 574-231-9188           FAX 419-776-1067

 

APPLICATION FOR CREDIT

 

NAME OF APPLICANT:__________________________________________________________________________________________________

 

BILLING ADDRESS (Street)________________________________________________________________  P. O. Box ______________________

 

City:______________________________________  State: _____  Zip: _________  Phone: ____________________ Fax:______________________

 

Website: ________________________________________________________________________________________________________________

 

Circle One:              Corporation            Partnership             Proprietorship        Personal                                  Other (specify) ___________________________

 

Date Established: ________________  State Incorporated: _________      Tax ID/EIN: _________________________________________________

 

Tax Exempt?  YES  /   NO    #_________________________      Purchase Order Required?  YES  /   NO        Credit Limit Requested?  $__________ 

 

A/P Contact: ______________________________________  Phone: ______________________________  Email: ___________________________

 

Purchasing Contact: ________________________________  Phone: ______________________________  Email: ___________________________

 

Receive emailed invoices/statements?    YES  /    NO      Email address:______________________________________________________________

 

                                                                                OWNERS, OFFICERS, PRINCIPALS, PARTNERS:

Name                                       Title                        Address                                                                                   Phone

________________________________________________________________________________________________________________________

 

________________________________________________________________________________________________________________________

 

________________________________________________________________________________________________________________________

 

       BANK REFERENCE (attach a voided check)

 

Bank Name:_______________________________________________  City, State: _______________________________ Phone:______________________________

 

Account #:________________________________________________  Contact:__________________________________  Fax:_______________________________

 

Bonding Company: _________________________________________  Phone:___________________________________  Fax: _______________________________

 

TRADE REFERENCES

 

Name: ___________________________________________________  Phone: ___________________________________  Fax: _______________________________

 

Name: ___________________________________________________  Phone: ___________________________________  Fax: _______________________________

 

Name: ___________________________________________________  Phone: ___________________________________  Fax: _______________________________

 

TERMS OF PAYMENT:  NET 30 from invoice date

 

A 1.5% per month service charge may be assessed on all unpaid balances.  Applicant agrees to pay any & all collection costs or fees, including reasonable

attorneys’ fees, upon delinquency in the account in excess of 60 days & following written notification.  Applicant consents to the jurisdiction of the county

 court of the local office for resolution of any disputes arising out of any transactions.

 

Signature:_________________________________________________________________________________________  Date:_______________________________

 

Printed: ___________________________________________________________________________________________  Title: ______________________________

 

     GUARANTY

The undersigned hereby agrees to personally guarantee payment of the above Applicant’s account, according to the terms of this Application for Credit, for all amounts charged:

  (required for all entities in business for less than 2 years)

 

Signature:________________________________________________ SS #: ______________________________________ Date: ______________________________

 

Printed: _________________________________________________  Bank: ______________________________________ Account #: _________________________