Credit Application-FL.htm

DRILLERS SERVICE, INC

CREDIT APPLICATION

(Florida Companies Only)

Company Name: ________________________________________________ Date: _________________

Mailing Address: _______________________________________________County: ________________

City: ________________________________________ State.: _________ Zip: ____________________

Shipping Address: ______________________________________________County: ________________

City: ________________________________________ State: __________ Zip: ____________________

Telephone: ( ) ______________________________ Fax: ( ) ______________________________

Sales Tax Exempt Number: _____________________________ (Attach copy of certificate)

Ownership: ( ) Individual ( ) Partnership ( ) Corporation

Full Name of Owner(s) or Officers:

____________________________________________ Title: ________________ SS# ________________

Other business interest now of owner(s) or officers: __________________________________________

______________________________________________________________________________________

Describe type of business and work performed: _____________________________________________

______________________________________________________________________________________

Works from: ( ) Home ( ) Shop Number of Employees:________Number of Trucks: ________

Date business started: ________________________ Annual Sales: $ __________________________

If new business, describe past employment (or if still employed): _______________________________
______________________________________________________________________________________

Are purchase orders required? _____________ Issued by Whom? ________________________

Estimated amount of credit needed monthly? : ______________________________________________

Special Billing Instructions: ______________________________________________________________

______________________________________________________________________________________

REFERENCES: (Four Current Suppliers Now Extending Credit)

Name Address City/St/Zip Telephone/Fax

Bank: ________________________________________________________________________________

Supplier: _____________________________________________________________________________

Are any of the above secured? If yes, explain: _______________________________________________

______________________________________________________________________________________

Name of Bank: _____________________ Phone: ( ) _________________ Branch: _______________

Address: __________________________ Acct#: ______________________ Officer: _______________

Owned Leased Financed Equipment

______ ______ ________ _________

Terms: The information given herein is offered as a request by the applicant for an extension of credit for commercial business use only. I/we authorize creditor to make inquiry into any & all matters set forth in this application & contract to obtain oral or written credit reports from my credit-reporting agency in gathering information necessary for the evaluation of my/our credit & financial responsibility. I/we further authorize the within-stated reference to release to creditor any information concerning the financial status of each of us individually, or of our business, partnership or corporation.

It is agreed & understood that Driller Service, Inc. (DSI) will, at all times, retain title to products purchased; & upon the sale of such products, title to the proceeds, shall vest in & remain the property of DSI until payment in full is made to DSI. As security for payment for purchase from DSI, I/we herby grant Drillers Service, Inc. a security interest under the Uniform commercial code in such products & the proceeds of any sale of such products by me/us. My/Our credit application, which is incorporated herein by reference, is the security agreement for all purchases. All purchases are subject to the approval of the DSI credit department.

Open account terms: Payment by the 10th of the month following purchase; net by the 25th of the month following purchase & considered past due on the 26th of the month following said purchase. A penalty charge of 1-1/2% per month (18% per annum) will be added to all amounts past due ($1.00 minimum). Additional terms, anytime part of the money you owe us is past due, we can ask for everything you owe to be paid in full, including special dating invoices. We have the right, in our sole discretion, to change any of the terms of this Agreement, including credit terms & finance charges. We will give you written notice of any change prior to the effective date of the change, & the change will become effective as stated in the notice. Both parties hereto agree that the laws of the State of North Carolina shall govern this & all transactions relating thereto. Customer consents and submits to the personal & subject matter jurisdiction of the Superior & District Courts of Catawba County, North Carolina or the United States District Court for the Middle & Western Districts of North Carolina with respect to any civil action involving enforcement or interpretation of the provisions of this Agreement, or any civil action for recovery of debts or obligations owed by Customer to Drillers Service, Inc. Customer further agrees that he shall be responsible for all collection fees, reasonable attorney�s fees, and court cost should they be incurred to collect this account. I/we agree to be bound by all provisions of this credit & security agreement and contract.

Application must be signed by owner(s) of business; or if a partnership, by all partners, or if a corporation, by an authorized officer.

____________________________________ ____________________________________

Name of Customer Customer�s Signature

____________________________________ ____________________________________

Customer�s Signature Customer�s Signature

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FOR OFFICE USE ONLY

Date Received: _________________

Salesman�s Name: ______________________________________ Account #: _____________________

Salesman�s #: __________________________________________ Credit Limit: ___________________

_____ New Account _____Customer Approved By: _________________

_____ Review Account _____ Request COD Date: ________ Entered CRT: ___