Cover Page for Service Auto Glass Credit Application:



CREDIT APPLICATION

Mail completed, signed application to: 833 47th Place, Attn: Credit Dept. Chicago IL 60609

To begin processing, you may fax your completed application to 773-847-6835, then mail the original, signed application to the above address.

Business type (check one): Proprietorship __ Partnership __ LLC __ Corporation__ Serving warehouse: _______ Sales Rep: _________

Business Name: _____________________________________ DBA Name: _________________________________________________

Address: ___________________________________________ Billing Address: ______________________________________________

City/State/Zip: ______________________________________ City/State/Zip: ______________________________________________

Telephone: _____________________________________ A/P Telephone: _____________________________ Ext: _____________

Date Business Established: ___________________ Contact Name: ______________________________________________

Federal Tax ID_____________ Estimated Annual Purchases: ________Requested Credit Line: ____________ Requested Terms_____________

Any Special Billing Requirements? ________________________________________________________________________________________

OWNERS, PRINCIPALS AND OFFICERS:

1) Name: _________________________________________ SS #: _____________________________ Title: ____________________________

Address: ________________________________________ City/State/Zip: ______________________________ Phone: ____________________

2) Name: _________________________________________ SS #: _____________________________ Title: ____________________________

Address: ________________________________________ City/State/Zip: ______________________________ Phone: ____________________

Bank and Trade References:

Bank Ref: ______________________________ Account #:__________________________________________ Phone: ____________________

Trade Ref: ______________________________ City/State/Zip: _______________________________________ Phone: ____________________

Trade Ref: ______________________________ City/State/Zip: _______________________________________ Phone: ____________________

CERTIFICATE OF EXEMPTION: The undersigned must provide a separate Sales Tax Certificate of Exemption if the tangible personal property purchased from Majestic Auto Glass is for the purpose of resale. The undersigned agrees to pay the state sales or use tax due in the event that any or all purchases made hereunder should be determined to be taxable.

TERMS AND CONDITIONS:

• I/We attest to my/our financial responsibility and ability and willingness to pay Majestic Auto Glass for all purchases made by me/us from Majestic Auto Glass according to Majestic Auto Glass’s stated terms. Unless otherwise mutually agreed upon in writing, Majestic Auto Glass’s stated terms are, “The unpaid balance is due in full upon receipt of the goods.” (COD).

• I/We agree that, in the event of legal action instituted to collect any unpaid balance due Majestic Auto Glass, I/We will pay all costs of collection, court costs and reasonable attorney’s fees incurred by Majestic Auto Glass as a result of said legal action. I/We further agree that, in the event any check for payment on my/our accounts is returned unpaid for any reason, Majestic Auto Glass is authorized to assess a Return Check Fee in the amount of $35.00 and to debit my/our account for the amount of said fee, in accordance with applicable state law.

• Unpaid balances will be subject to a FINANCE CHARGE. FINANCE CHARGE is computed by a "PERIODIC RATE" of 1-1/2% PER MONTH which is an ANNUAL PERCENTAGE RATE of 18% applied to all invoices not paid by the due date. ADDITIONAL LATE FEES MAY ALSO BE ACCESSED.

• I/We give my/our consent to any of the bank or trade references listed to release information regarding my/our checking and savings accounts, loans, accounts or other types of credit transactions.

• I/We further authorize Majestic Auto Glass to investigate my/our credit worthiness and to obtain reports from any credit reporting bureaus.

BY SIGNING BELOW, I/WE CERTIFY THAT I/WE HAVE READ AND AGREE TO THESE TERMS AND CONDITIONS.

_____________________________________ ___________________________________ ______________________

NAME (please print) (SIGNATURE) (DATE)

_____________________________________ ___________________________________ ______________________

NAME (please print) (SIGNATURE) (DATE)

PERSONAL GUARANTY

The undersigned unconditionally guarantees the payment when due of all amounts owed by the above named business and waives all notice to which the undersigned may otherwise be entitled, including but not limited to notice of acceptance, extension of credit and presentment, and consents to any extension of forbearances.

_____________________________________ ___________________________________ ______________________

NAME (please print) (SIGNATURE) (DATE)

_____________________________________ ___________________________________ ______________________

NAME (please print) (SIGNATURE) (DATE)

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