CreditApp.pdf - Me

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421 Southwest Blvd, Kansas City, MO 64108 955 Decatur St, Unit A, Denver, CO 80204 TF: 1 (800) 821-2254 TF: 1 (800) 525-2484 Local: (816) 421-3600 Local: (303) 573-1766 Fax: (816) 421-5671 Fax: (303) 893-3028 www.foxxequipment.com @foxxequipmentcompany @foxxequipment /foxx-equipment-company CREDIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL AND SIGNED BEFORE CREDIT CAN BE PROCESSED Date: Company Name: Business Phone Number: Fax Number: Street Address: City, State, Zip: Account Payable/Name: Email: Purchasing Department/Name: Email: Tax Exempt: ☐ Yes ☐ No IF YES, PLEASE PROVIDE A COPY OF EXEMPTION CERTIFICATE(S). Type of Ownership: ☐ Corporation ☐ Partnership ☐ Individual Type of Business (check one or more as applicable): ☐ Bottler/Beverage Distributor ☐ Beer Distributor (brands): ☐ Brew Pub/Brewery ☐ Home Brew/Home Wine Shop ☐ Food Service Distributor ☐ Bar/Restaurant ☐ Fast Food/Chain Restaurant/C-Store ☐ Liquor Retailer ☐ Beer/Liquor Wholesaler ☐ Institution (hospital, school, hotel, casino) ☐ Individual ☐ Vending/Office/Coffee/Catering ☐ Refrigeration/Ice Machines Sales & Service ☐ Welding/Carbonic Gas ☐ Other: Business Establishment Year: D&B Number: How did you hear about Foxx Equipment Co.? APPLICATION IS HEREBY MADE AND THE FOLLOWING REFERENCES ARE GIVEN. IT IS UNDERSTOOD THAT THE INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE AND USED ONLY BY FOXX’S CREDIT DEPARTMENT Trade Reference: Bank Reference: Address: Address: City, State, Zip: City, State, Zip: Phone: Phone: Fax: ☐ Savings: Account No.(s) List names of principal company officers or owners: ☐ Checking: Name: Title: Name: Title: PLEASE NOTE: FOXX EQUIPMENT COMPANY terms are NET 30 DAYS. A finance charge of 1.5% per month (which is an annual percentage of 18%) is charged on all past due accounts. The purchaser will be responsible for all collection costs if invoices are not paid pursuant to the terms and conditions of this application. By signing, you authorize each reference listed above to release information to FOXX EQUIPMENT COMPANY by telephone, fax, mail or email; and that you understand Foxx Equipment Company’s terms and agree to abide by them. X: Date: Authorized Signature