Commercial Credit Application _MS Word - 89 Kb_ - www .doc by lovemacromastia

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									                                        COMMERCIAL CREDIT APPLICATION

     Legal Name of Business__________________________________________________________________
     Street Address__________________________________________________________________________
     City____________________________________________State____________Zip___________________
     Billing Address (if different) ______________________________________________________________
     City____________________________________________State____________Zip____________________
     Phone: (    )____________________________________Fax (        )______________________________



                                         BUSINESS INFORMATION

  Date Business Started_______________________ Nature of Business________________________
  Organization: ___ Corporation ____ Sole Owner _____ General Partnership _____ Ltd. Partnership

                             List Corporate Offices, Sole Owner, or Partner Below
    Full Name: _____________________________Title: _______________________________
              SSN____________________ DOB ___________________________
       Address ______________________________________________________________
      City _____________________________ State _____________________Zip ________
    Full Name: _____________________________Title: _______________________________
              SSN____________________ DOB ___________________________
       Address ______________________________________________________________
      City _____________________________ State _____________________Zip ________

  Is Business listed by Dunn & Bradstreet? No ___ Yes ___ Dunn’s #___________Rating _________
  Does Business have any outstanding or pending litigation or judgements? No ______ Yes _______
  Has the company or its principal owners filed bankruptcy in the last seven (7) years? No __ Yes __
  If incorporated, who is your registered agent? ___________________________________________
  Requested Credit Line? _________________



                                           Trade or Credit References
     Main Bank _____________________________________________________________________________
     Address ________________________________________________________________________________
     City ____________________________________ State ___________________ Zip ____________________
     Phone Number ________________________________________ Fax Number_______________________
     Bank Officer responsible for account _________________________________________________________



Three largest trade or credit references:
Name                         Address (required)          Fax Number (required)
                                                         CREDIT AGREEMENT

                                                              AUTHORIZATION

The applicant acknowledges and agrees to the need for verification of all information on this application. Applicant hereby authorizes all
banks, businesses, and persons identified on this application to disclose and furnish (both in writing and verbally), any and all information
requested by Southwest Georgia Oil Company, by telephone, fax, or written correspondence and hereby releases, waives and disclaims any and
all claims against Southwest Georgia Oil Company, and all such banks, businesses, and persons arising out of such disclosures. Buyer further
authorizes Southwest Georgia Oil Company to obtain a full and complete credit history.

                                               CREDIT APPLICATION TERMS AND CONDITIONS

In consideration of the offer to extend credit, and for other good and valuable consideration received, or to be received by the Applicant, the
Applicant, by the signature of its authorized representative set forth below, hereby agrees to the terms and conditions set forth in this document.
DO NOT SIGN UNLESS YOU HAVE READ, AND AGREED TO, THE PROVISIONS OF THE CREDIT AGREEMENT SET
FORTH BELOW.

DEFAULT
It is understood and agreed that all invoices for purchases under this Credit Agreement shall be paid in full by the 15 th day of each month. In
the event Applicant is delinquent in payment at any time, Southwest Georgia Oil Company will charge the Applicant a past due service charge
at the rate of 1 1/5% per month (18% per annual) , or the maximum legal rate, whichever is less. In the event that any collection efforts are
implemented, or litigation is initiated to enforce the terms of this Agreement, Applicant hereby agrees to pay all costs of collection, including
any attorney fees which may be incurred by Southwest Georgia Oil Company in its collection efforts or in the enforcement of the terms and
conditions set forth on this Agreement. Any returned checks will be charged back to the Applicant along with a $35.00 handling fee.

PROHIBITION AGAINST DISCRIMINATION
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status,
or other discriminating basis. The federal agency that administers compliance with this law concerning Southwest Georgia Oil Company, is the
Federal Trade Commission, 730, Peachtree Street, NE, Atlanta, Georgia, 30308. Southwest Georgia Oil Company has the right to deny credit
to any applicant and retains the right to close any account initiated by this agreement whenever it deems necessary. In such instances,
Southwest Georgia Oil Company will give a statement of its reason for such action as required by federal law. Applicant acknowledges that
such credit, if granted, shall not be used for consumer purchases, but rather for business, agricultural or commercial purposes, only.

                                                      UNCONDITIONAL GUARANTY

The undersigned individual, jointly, severally and unconditionally, guarantees the payment and performance by the Applicant of the
terms and conditions of this Credit Agreement. The undersigned further agrees to pay all costs of collection incurred Southwest
Georgia Oil Company in the event of default by the Applicant, and/or arising out of an action to enforce this guaranty, including
reasonable reasonable attorney’s fees. The undersigned certifies that all information set forth herein is true and correct. Executed the
date set forth below.


Printed Name of Applicant                                                         Printed Name of Guarantor


Printed Name of Authorized Representative                                         Signature of Guarantor



Signature and Title of Authorized Representative                                  Date




PLEASE FAX TO 229-246-2009

								
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