FIRM NAME: _____________________________________ TELEPHONE
ADDRESS: ______________________________________________ FAX
CITY: STATE: _________ ZIP CODE:
REQUEST:
AMOUNT OF CREDIT REQUESTED:_______________
PAYMENT PERSONALLY GUARANTEED?
YES NO
IF YES BY: ____________________ POSITION IN THE COMPANY:
TYPE OF ENTITY:
CORPORATION (if you are using a fictitious business name, please include the fictitious business name.)
LIMITED LIABILITY COMPANY RESALE #:(FL only)_________________________
LIMITED PARTNERSHIP FEDERAL TAX I.D. #:_______________________
PARTNERSHIP DUNS #:
SOLE PROPRIETORSHIP DATE BUSINESS STARTED:
OWNERSHIP
Name of owner:_______________________ Telephone #:________________
Address: City:___________ State:________ Zip Code:
Name of owner:_______________________ Telephone #:________________
Address: City:___________ State:________ Zip Code:
BANK REFERENCES
Name:________________ Account #:____________Telephone #:____________ Contact Person:
Address: City:___________ State:________ Zip Code:
Name:________________ Account #:____________Telephone #:____________ Contact Person:
Address: City:___________ State:________ Zip Code:
(Please list all and any other banks your company uses for business.)
TRADE REFERENCES: (please list three (3) minimum)
Name: _________________________________ Contact Person: ______________ Telephone #:
Address: City: State:_____________ Zip Code
Name: _________________________________ Contact Person: ______________ Telephone #:
Address: City: State:_____________ Zip Code
Name: _________________________________ Contact Person: ______________ Telephone #:
Address: City: State:_____________ Zip Code
LANDORD:
Name: _______________________ Contact Person:_________________ Telephone #: ___
Address: City: State:_____________ Zip Code
We certify that all the information listed above is correct and agree to the credit terms of 2%/10 days, net 30 days. Discounts and PREPAID Freight allowances based upon volume apply only to invoices paid within terms. Accounts over thirty days will be charged 1.5% interest per month, or the highest interest rate allowed by law. Should collection procedures become necessary, reasonable collection and legal fees shall be paid.
Please print full name, title/ position, date, and sign as an individual.
Name Title
Signature Date
The within guarantee is made for the benefit of, and to obtain credit on a continuing basis from Horticultural Alliance, Inc. The undersigned hereby guarantees the performance of all obligations of ______________________________, including but not limited to payment of all present and future indebtedness to Horticultural Alliance, Inc., whether secured or unsecured and regardless of how the indebtedness is represented or incurred and regardless of prior notice, demand or pursuit of remedies against the party primarily liable. The undersigned consents to any extension or alteration of any obligation and guarantees such with out prior notice. This guarantee shall continue in effect until the undersigned has notified Horticultural Alliance, Inc. in writing via certified mail of its cancellation, but such cancellation shall not alter any obligation of the undersigned arising thereunder prior to receipt of such written notice.
The undersigned hereby authorizes Horticultural Alliance, Inc. or its agent to investigate his/her credit and authorizes any bank, mortgage lender or landlord, credit reference or any other party to release information to Horticultural Alliance, Inc. or its agent, and hold harmless for said disclosure. The undersigned grants a security interest in all goods sold, and agrees to pay reasonable attorney’s fees and cost of collection and interest at the maximum legal rate in the event of any default under this obligation.
Name Social Security # __________________________
Signature Date
The entire contents of this document are ©
1997-2009, by Horticultural Alliance, Inc.
1550 66th Ave. Dr. East
Sarasota, FL 34243
800-628-6373, 941-739-9121
888-386-4478, 941-752-1890 Fax