Please fill out completely

CREDIT APPLICATION CREDIT APPLICATION
Please fill out completely 945 E Curry Rd
945 E. Curry Rd. Tempe,
• Tempe,AZ
AZ85281
85281
Phone
(480)
894-6000
Phone 480.894.6000 • Fax 480.894.6015
Fax (480) 894-6015
Acct. # ____________ Date ____________ Firm Name ___________________________________________ S.S. No. / Tax ID No.__________________ Billing Address ______________________________________________________ Phone ________________ City ____________________________________ State ______ Zip ___________ Fax __________________ Location Address ____________________________________________________ Phone _______________ City ____________________________________ State ______ Zip ___________ Fax _________________ Principal Business Activities _________________________________________________________________ Billing Email
Address
Principal Business Activities
Years in Business _____ Are you Incorporated? ______ What Year? ______ In What State? _____________ List Principal Owners or Corporate offices: Home Address and Phone 1. ____________________________________Phone________________ Title ______ S.S. No. __________ Address_________________________________________City _______________ State ____ Zip _________ 2.____________________________________Phone_________________ Title _____ S.S. No. __________ Address _________________________________________City _______________ State ____ Zip _______ 3. ___________________________________Phone ________________ Title ______ S.S. No. __________ Address _________________________________________City _______________ State ____ Zip ________ 4.____________________________________Phone_________________ Title ______ S.S. No. _________ Address _________________________________________City _______________ State ____ Zip ________ Name of Bank _______________________________________ Acct. No. ____________________________ Branch ___________________________ Contact ____________________________ Phone _____________ Current Supplier of Gases and Welding Equipment? _______________________________________________ LIST ACCOUNTS WHO HAVE EXTENDED YOU CREDIT FOR MORE THAN 12 MONTHS. NO CREDIT CARDS. Company_____________________________________ Address ____________________________________ City __________________________ State ____ Zip ________ Phone ______________ Fax ___________ Company ____________________________________ Address ____________________________________ City __________________________ State ____ Zip ________ Phone _____________ Fax ____________ Company _____________________________________ Address ____________________________________ City ___________________________ State ____ Zip ________ Phone _____________ Fax ___________ Company ____________________________________ Address ____________________________________ City __________________________ State ____ Zip ________ Phone _____________ Fax ___________ Do you require Purchase Orders? Yes ( ) No ( ) ALLIED GASES SALE REP. _____________ Your anticipated monthly Purchases? $250 ( ) $500 ( ) $1000 ( ) $5000 and up ( ) To be exempted from paying sales taxes a “TRANSACTION PRIVILEGE TAX EXEMPTION CERTIFICATE” must be filled out completely before the purchase is made. OUR TERMS ARE NET 30 DAYS from date of invoice. Delinquent thereafter. Overdue accounts are subject to service charges of $1.00 minimum per month, or an annual percentage rate of 21% (periodic monthly rate of 1 3/4% on total past due balance over 30 days) whichever is greater. NOTE:
The
Buyer
shall
return
all cylinders
to the
when w
empty.
Buyer
pay
to the
Seller
at SSeller’s
for loss
NOTE: Basis
Basis on
on which
which ALLIED
ALLIED cylinders
cylinders are
are loaned.
loaned. The Buyer shall return all cylinders to Seller
the Seller hen eThe
mpty. The shall
Buyer shall pay to the eller at price
Seller’s price for or
unauthorized
detention
or damage
on any of
or fittingsoresulting
any cause
the w
control
possession
The oBuyer
agrees
pay the
loss or unauthorized detention or damage on said
any cylinders
of said cylinders r fittings from
resulting from while
any cin
ause hile in orthe control oof
r pBuyer.
ossession f Buyer. The toBuyer agrees Seller rental at the standard rate on each cylinder. The Seller reserves the right to demand return of all cylinders, full or empty 30 days after the invoice date. Title to the
to pay the Seller rental at the standard rate on each cylinder. The Seller reserves the right to demand return of all cylinders, full or empty, 30 days after the invoice goods shall not pass to the Buyer until all sums due under this contract are paid in full. The Buyer accepts and acknowledges receiving the goods in good operating condition
date. and
agrees that until the full price is paid he will not sell, mortgage, pledge, or otherwise dispose of them or remove or permit them to be removed from the above premises,
Title to the
the prior
goods shall consent
not pass o the Buyer until all sums Indue nder these
this contract are paid in full. he Baccount
uyer accepts nd placed
acknowledges receiving the goods without
written
oftthe
Seller,
or his
assignee.
theuevent
terms are
not
fulfilled
and Tthe
has to abe
in the hands
of a attorney
or in good collection
for collection,
hethat will pay,
addition
to the
reasonable
amountpledge, of attorney
and/or collection
fees
costs.
a material
operating agency
condition and agrees until inthe full price is pamount
aid he due,
will naot sell, mortgage, or otherwise dispose agency
of them or and
remove or As
permit them inducement
to be to
Allied Gases
goods
and services
tothe Buyer,
the
undersigned
being
a principle,
officer,
director or
Buyer, does
removed from providing
the above premises, without prior written consent of the Seller, or his assignee. In other
the eauthorized
vent these representative
terms are not offulfilled and ahereby
ccount agree
has to onbe behalf of himself and his martial community to be personally and primarily liable to Allied Gases as a co-obliger together with Buyer, individually and in his personal capacity
placed n the has
ands of a attorney or and
collection agency of
for collection, he be
will pay, toin Allied
addition to the amount due, a reasonable amount of attorney and /or collection and
not imerely
a guarantor
for any
all obligations
Buyer
that may
owed
Gases.
agency fees {1)
and costs. The undersigned, being rincipal, d(2)
irector or officer of the aforesaid business, individually, jointly isand severally guarantees the payment RETURNS:
There
is no
refund
for contents
left ain pcylinders.
All claims
for shortages
must be made
within
3 days. (3) There
a 15%
minimum
restocking
charge
for of stock
items.
Special
order oronon-stock
are returned
minimumR25%
restocking
The
of venue
agreed to
be in any and all f(4)
uture obligations f the said items
business which mto
y bALLIED
e owed GASES,
to Allied option
Gases subject
upon ito
ts ademand. ETURNS: (1) Tcharge.
here is no place
refunds for cisontents left Maricopa County Arizona. This Credit Application shall not obligate Allied Gases to provide any goods or services unless and until it is accepted be the signature of a duly
cylinders. Allied
(2) AGases
ll claims for shortages must be the
made wApplication
ithin 3 days. 3) There is a 1between
5% minimum restocking charge for stock items. (4) Special order authorized
representative,
at which
time
Credit
shall (form
a contract
Buyer and
Allied Gases,
enforceable
in accordance
with
its terms.
or non stock items are returned at ALLIED GASES, option subject to a minimum 25% restocking charge. The place of venue is agreed to be BUYER
SELLER
Maricopa County Arizona. Corporate Officer Signature______________________________________
Corporate Officer Signature______________________________________
_______________________________________ ______________ ______________________________________ ______________ Printed NameO
________________________________________________
Printed
Nameo________________________________________________
Corporate fficer Signature (Only) Date Printed Name f Corporate Officer Title Date_____________________ Title ______________________________
Date_____________________ Title ______________________________