Heating and Cooling Supply Co
Heating and Cooling Supply Co.
255 Prospect Pl SW 105 Broadway St 3100 Delaware Ave 16935 210th St.
Cedar Rapids, IA 52404 Waterloo, IA 50703 Des Moines, IA 50313 Davenport, IA 52804
APPLICATION FOR CREDIT
Company Name:_______________________________ County:__________________________
Street Address:___________________________P.O. Box:____________ City:______________
State:__________ Zip Code:____________ Phone:________________ Fax:________________
Legal Identity (Please Circle): Corporation Partnership Sole Proprietorship
If Sole Proprietorship or Partnership list the following information for all principals.
Name:_________________________ Name:_________________________
Home Address:__________________ Home Address:__________________
Phone:_________________________ Phone:_________________________
SS#:___________________________ SS#:___________________________
Years in Business:_______ P.O. Required:________ Fed ID#____________
Purchases will be: Taxable____ Tax Exempt____ Attach Sales Tax Exempt Form
(Providing only resale number is not sufficient)
BANK REFERENCE
Name:______________________ Address:______________________ Phone:______________
TRADE REFERENCES
Name:______________________ Name:__________________________
Address:____________________ Address:________________________
Phone:______________________ Phone:__________________________
Fax:________________________ Fax:____________________________
CONTACT INFORMATION
Please list all pertinent employees:
Contact:______________________ Cell Phone:________________ E-Mail:_______________
Contact:_______________________ Cell Phone:________________ E-Mail:_______________
Contact:_______________________ Cell Phone:________________ E-Mail:_______________
Contact:_______________________ Cell Phone:________________ E-Mail:_______________
TERMS AND CONDITIONS OF SALE AGREEMENT (must be signed to obtain open account)
Applicant agrees that extension of credit by seller shall be subject to and in consideration with the attached terms and conditions.
Accepted By:_____________________________ Title:__________________ Date:_________
GUARANTY (must be signed to obtain open account)
In consideration of credit granted to the above named Company, the undersigned does hereby personally and unconditionally guarantee payment of all the Company’s present and future obligations to Heating and Cooling Supply Co. including interest and service charges. The undersigned and each of us agree to pay Heating and Cooling on demand any sum, which may become due to Heating and Cooling by the Company, whenever the Company shall fail to pay the same. In the event suit is instituted to collect amounts owing to Heating and Cooling and judgment is rendered in Heating and Cooling’s favor I/we agree to pay court costs and reasonable attorney’s fees. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the Company. I/we do hereby waive notice of default, non-payment and notice thereof and consent to any modification of renewal of the credit agreement hereby guaranteed.
Guarantor:________________________ Guarantor:___________________________
Signed:___________________________ Signed:_____________________________
Date:_____________________________ Date:_______________________________
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