DEPATIE FLUID POWER COMPANY
P
O
PHONE 269-324-2850
APPLICATION FOR CREDIT
Name of Firm____________________________________________________
Address_________________________________________________________
City__________________________ State_____ Zip_______
Area Code & Phone #____________________ Area Code & Fax #____________________
ALL INVOICES WILL BE FAXED. PLEASE INDICATE YOUR ACCOUNTS PAYABLE
FAX #_________________________
The above named company hereby applies for credit in accordance with the following terms & conditions:
1) Terms: Net 30 days from date of invoice, orders held @ 45 days, orders placed on COD @ 60 days.
2) A return authorization number is required prior to returning any goods. Restocking charges may apply to returns.
3) We do accept VISA/MASTER CARD AND DISCOVER.
4) You agree to pay a service charge of 1.5% per month (which is an annual PERCENTAGE RATE of 18%) on any past due balance.
5) You agree to pay all costs of collection, including actual attorney fees on any past due account.
6) You grant us a security interest in all goods purchased and authorize us to sign on your behalf such documents as are necessary to perfect our security interest.
OWNERSHIP___Corporation ________________Federal ID# _________________Date Established
___ Other _______________________________________________________________
1) _________________________________ ____________________________________
Name of Principal Phone #
2)__________________________________ ____________________________________
Name of Principal Phone #
3) _________________________________ ____________________________________
Name of Principal Phone #
Bank Name, address, phone and contact______________________________________________________
Business Name Phone # Fax # Acct. #
Business Name Phone # Fax # Acct. #
Business Name Phone # Fax # Acct. #
The undersigned certifies that all information on this form is correct and fully understands your credit terms. You are authorized to investigate our credit record to the extent you deem necessary and to verify references. The undersigned instructs all entities to furnish any information that they may have in response to your inquiries.
______________________________________________________
Date Signed Title