McPhersons

P.O. Box 188, 957 North Meridian Street

Sunman, Indiana 47041

CREDIT APPLICATION AND CONTRACT

Please complete this application, print and return it to the attention of the credit department to be considered for an open account.

OFFICE USE ONLY

   Customer #_______________  Date Approved________________ Terms Granted______________ Credit Limit_____________

Company Name

Street Address

Mailing Address

Telephone 1

Telephone 2

Bookkeeper

City,State,Zip

Email Address

Fax #

Date Established

Principal Owners, Officers, or Stockholders

Last Name, First, Middle

Position/Title

Soc. Sec. Number

Home Address

Owner's Home Phone

Has this business or the owner of this business filed bankruptcy in the last seven years?

Yes

To help us determine your credit limit, please answer the following questions:

No

What is the high credit you desire?

$

Subsidiary of another company

Has the owner of your business purchased goods from us under any other business name?

Branch of a company (Please list additional branches and locations on a separate piece of paper and attach it).

Sole Proprietorship

 

Partnership

 

Corporation

 

State

No

Yes

If yes, under what name and address:

Name

ID#

Address

What form of Credit Terms are you interested in?

 

"C.O.D." only

 

"Cash or Check in Advance" at time of placing orders.  Note:Any shortage over $10.00 will be shipped COD.

 

"Open Account", (Granted only after Credit Application is approved)

Accounts Payable Contact

Home Office

Telephone#

Address

Contact

Bank Reference

Bank:

Address:

City,State,Zip

Telephone:

Checking Acct #

Fax #

Years dealing with

If less than 2 years, please provide Bank Information previously dealt with.

Supplier 1 Reference

Supplier:

Address:

City,State,Zip:

Telephone:

 Acct #

Fax #

Years dealing with

Supplier 2 Reference

Supplier:

Address:

City,State,Zip:

Telephone:

 Acct #

Fax #

Supplier 3 Reference

Supplier:

Address:

City,State,Zip:

Telephone:

 Acct #

Fax #

Years dealing with

Years dealing with

Credit Policy

Payment Terms:Due on receipt with approved credit, Check With Order/C.O.D. without approved credit.  Our credit policy states that any incoming orders cannot be processed until all past due amounts have been paid.  All orders for $1,000.00 or more wholesale must be accompanied by 50% of the wholesale amount.

Invoicing and Statements:The original invoice will be included with each order.  A statement will be issued if there is a balance outstanding at the end of the month.  A finance charge equal to the lesser of 1.5% per month or the maximum amount allowed by law will be added to your account for any past due balance and a $30.00 service charge will be assessed for any returned check.

In the event payment is not made when due,  you agree to pay all reasonable costs of collection including any attorney fees, collection agency fees or other charges or fees incurred in our attempts to collect a delinquent account.

Payments: Please return the remittance stub with your check to the mailing address indicated on your statement.  Note:Please be advised that if payments are not received in a timely manner, you will be subject to having all future orders held and your line of credit removed.

Credit Department:The Credit Department is willing to work with you if a problem should arise.  Communication with us will avoid misunderstandings which could impair your credit with McPhersons.  Questions about your credit terms may be addressed to the Credit Department.  Feel free to call us between 7:30-4:30 p.m. E.S.T.

I, an authorized officer, partner or sole proprietor of this company, certify that the above information is correct and agree to the terms and conditions set forth above.  As part of the application for credit, I grant McPhersons permission to contact consumer credit reporting agencies, commercial credit reporting agencies, bank and trade reference as necessary.

I, an authorized officer, partner, or sole proprietor of this company, certify that the above information is correct.  As part of the application for credit, I grant permission to contact consumer credit reporting agencies, commercial credit reporting agencies, as well as bank and trade references as necessary.

Signature:  _____________________________________________________

Type Signature

Date:

Accounts Receivable Phone: 800-535-6330    Fax: 800-626-3670