CREDIT APPLICATION SHIP TO BILL TO

CREDIT APPLICATION
Terms of payment will be C.O.D. until applicant has been notified
by Scavuzzo’s Credit Dept. that credit has been approved.
SHIP TO
BILL TO
Accounts Payable Contact
Firm Name
Prefered Contact Method
Address
Trade Name
City, State, Zip
Address
Phone No.Fax No.
City, State, Zip
Email Address
Phone No.
OWNERSHIP INFORMATION
Corporation
Partnership
Sole Proprietor
Healthcare
Group Purchasing
(If Incorporated): Name
School
Date
In Business Since:
State
Has Business Filed Bankruptcy?
Yes
No
PURCHASES, STATEMENTS, TERMS, METHOD PAYMENT:
Estimated Weekly Purchase: $Payment Method:
ACH
CHECK
CREDIT CARD
CASH
PLEASE LIST ALL OWNERS, PARTNERS, CORPORATION OFFICERS
NameDate of Birth
NameDate of Birth
Title
Title
Home Address
Home Address
Phone No.
Phone No.
Social Security No.
Social Security No.
NameDate of Birth
NameDate of Birth
Title
Title
Home Address
Home Address
Phone No.
Social Security No.
Phone No.
Social Security No.
BANKING INFORMATION
Bank Name
Officer Phone No.
Address
Checking Account No. Balance
City, State, Zip
Loans Balance
BANKING INFORMATION
Tax Exemption Status:
Resale Only
YES
NO
Resale Tax ID Number
All Sales
YES
NO
Tax Exempt ID Number
In consideration of the granting and extension of credit by Scavuzzo’s Inc to the undersigned, it is hereby agreed that the undersigned will promptly pay all sum when due.
In the event of non-payment, the undersigned does hereby agree to pay in addition to the principle amounts due, all collection and/or attorney’s fees and all court costs.
Signature
Printed Name
Title
SALES AFICIONADO
WE LOVE WHAT WE DO.
SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120
Date
CREDIT CARD AUTHORIZATION
SHIP TO ADDRESS
Business Name
Street
City, State, Zip
Phone No.
Fax No.
I, Hereby authorize Scavuzzo’s Inc. to charge my credit/debit card ac-
count for services rendered/products sold to all people using my customer account number/numbers even though the card is
not present at the time of transaction/delivery. This continuing authorization is valid until such time as I inform Scavuzzo’s Inc
in writing to the contrary.
Cardholder’s SignatureDate
CREDIT CARD INFORMATION
Visa
Mastercard
American Express
BILLING ADDRESS
Discover
Name on Card
Street
Credit Card Number
City, State, Zip
Expiration Date
Phone No.
Name of Issuing Bank
Fax No.
Upon Delivery of order, the credit/debit card account above will be charged for the full amount of the purchase.
If product is to be picked-up at Scavuzzo’s Inc and not picked up within 2-3 days of pick-up request,
then a restocking fee will be charged.
SALES AFICIONADO
WE LOVE WHAT WE DO.
SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120
ACH / DEBIT AUTHORIZATION
I, Hereby authorize Scavuzzo’s Inc. to initiate debit entries to the
account indicated below.
ACCOUNT INFORMATION
DDA
SAV
Receiving Bank’s Routing No. [ABA]
Account No.
Name
This authority is to remain in full force and effect until Scavuzzo’s Inc has received written notification from me
of it’s termination in such time and such manner as to afford Scavuzzo’s Inc a reasonable opportunity to act on it.
Printed Name
Signature
Date
SALES AFICIONADO
WE LOVE WHAT WE DO.
SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120
PERSONAL GUARANTY
For value received and to induce you to extend credit hereunder, the undersigned jointly and severally guarantee payment of
any and all indebtedness, which (Hereinafter “Company”) has in-
curred or may incur in the performance of all obligations of said company to Scavuzzo’s Inc. That liability of the undersigned
shall not be affected by the amount of credit extended hereunder, by an change in the form of indebtedness, by note or otherwise, or by renewal or extension thereof. Notice of acceptance of this guaranty, of the extension of said indebtedness, of orders,
of deliveries, of default in payment, of the release of the whole or part of the indebtedness, or of any other matter with respect
hereto, is waived. This guaranty shall be enforceable before or after any proceeding against the company and shall be effective
regardless of the solvency of the company, the subsequent incorporation or failure of incorporation, the assignment, transfer
or sale of said company or by any other change in the composition, nature, personnel or location of the company. Should this
matter be referred to an attorney for collection, the undersigned shall pay all expenses of collection and attorney’s fees incurred by reason of the default of the company.
The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in the evaluation of this personal guaranty, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by
the above named business credit grantor, from time to time as maybe needed, in the credit evaluation process.
Execution Date Of
NameDate of Birth
NameDate of Birth
Home Street Address
Home Street Address
City, State, Zip
City, State, Zip
Social Security No.
Social Security No.
Signature
Signature
A copy of your identification will be necessary to confirm the above printed information.
SALES AFICIONADO
WE LOVE WHAT WE DO.
SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120