Credit Application – Northwestern Supply, Inc.

Credit Application: Open Account and Payment Guarantee

Company Name (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Email address

______________________________________________________________________________________________________

Business Type (required)

Year Established (required)

Date Inc.

Name of Principal (required)

Billing Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Drivers License Number (required)

Drivers License State (required)

Federal ID Number

Social Security Number (only sole proprietorship)

Name of person to contact regarding invoices (required)

Title

Phone Number

Email Address

______________________________________________________________________________________________________
Credit References

Name (1)

Address (1)

Name (2)

Address (2)

Name (3)

Address (3)

Bank (required)

Bank Address

Account Number

Contact Person

______________________________________________________________________________________________________
Terms and Conditions

In consideration of the extension of credit to , I/we do hereby agree to pay all bills rendered within the terms of payment as specified by Northwestern Supply, Inc. It is understood that failure to pay within said terms will permit Northwestern Supply, Inc. to assess a finance charge of 1 1/2 % per month or 18% per annum on all past due amounts. A finance charge will be assessed after due dates.

After default by the debtor ; at the option of Northwestern Supply, Inc. shall cause acceleration of all amounts due along with any penalties on those amounts and in that account as of the date of default without prior notice from Northwestern Supply, Inc. Northwestern Supply, Inc. shall have its option the repossession in resale of goods that are the subject of credit and deficiencies after sale under the terms of the South Carolina commercial code. Northwestern Supply, Inc. disclaims any and all warranties of the goods among them implied warranties except those of the manufacturer. Should there be a conflict between this disclaimer and those put forth by the manufacturer that this claimer applies such that the only warranties are those of the manufacturer of the goods. In the event that Northwestern Supply, Inc. deems necessary that to place this account with a collection agency and/or any attorney at law for this collection, then in that event, I/we agreed to pay the additional and further sum of any and all cost of collection incurred by Northwestern Supply, Inc. including, but not limited to collection agency fees, attorney’s fees and court costs. I/we fully understand that the purpose of this provision is to identify northwestern Supply, Inc. against any and all costs or expense arising out of any failure to pay an account
when due.

Payment Guarantee

In consideration of the mutual promise contained herein as well as the extension of credit by Northwestern Supply, Inc. to , I/we do hereby
unconditionally, jointly, severely and individually personally guarantee payment and the full and faithful performance of any and all obligations arising out of the said extension of credit by the said Northwestern Supply, Inc.

To , this guarantee shall remain in full force and effect until the same is revoked in writing to Northwestern Supply, Inc. by the undersigned and with the reasonable approval of Northwestern Supply, Inc. The revocation by the said guarantor with the approval of Northwestern Supply, Inc. will effect only credit extended after the date of receipt in the guarantee will be a full effects as to any debt incurred prior to the receipt of said revocation. Assignment of the guarantee must be with the prior written approval of Northwestern supply, Inc.

Dated at Northwestern Supply, Inc. on this Day of , 20 .

Guarantor Guarantor

The above information is herewith submitted for the purpose of opening an account and I do hereby certify this information is to be true. I also agree to comply with the above said provisions.

Signed: Title: Date:
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