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Legal Name of Business___________________________________ Date________________________
DBA_________________________________________ Line of Credit Needed____________________
Mailing Address__________________________ Do you always issue purchase orders?________
City_____________________________________ State______________ Zip_____________________
Shipping Address______________________________________________________________________
City________________ State______ Zip_________ Phone#____________ Fax#_________________
Nature of Business: Retail_____________________ Contract/Commercial___________________
Type of Store___________________________________________ No. of Locations_____________
How Long in Business?__________________________ Certificate of Resale #_______________
Name of: P/A or Buyer__________________________ A/P Supv or Controller________________
Do you Own or Lease Premises?__________________ If Rent Name of Landlord______________
How Long Occupied Current Premises?____________ Address of Landlord___________________
If you are a Sole Proprietorship, please list name of owner below.
If you are a Partnership, please list names of partners below.
If you are a Corporation, please list names of three (3) top executives below.
Name & Title____________________________ Name & Title_________________________________
Address_________________________________ Address______________________________________
________________________________________ _____________________________________________
Length of Service_______________________ Length of Service____________________________
If any of these employees have been with your
Name & Title____________________________ company less than 2 years, attach a separate page
Address_________________________________ listing previous employer. Also, if any were
________________________________________ involved in any Bankruptcy Proceedings in the
Length of Service_______________________ past seven (7) years include all details.
Statement of Terms and Conditions
The statements of this form are submitted for the purpose of obtaining credit and are certified to be true and correct. I authorize Kinder-Harris, Inc. to obtain such information as they may require concerning the statements made in this application and agree that the application shall remain their property whether or not credit is granted. I declare the foregoing statement is true in every respect. The following terms and conditions are applicable to all open account purchases from Kinder-Harris, Inc. Net 30 days from date of invoice. If an account is not paid within 30 days from date of invoice, the account is considered past due and in default, and interest will be charged from the date of default until payment is made in full at the following annual percentage rates:
| Arkansas |
The percentage rate shall be 5% above the Federal Reserve Discount Rate on 90 days commercial paper in effect in the Federal Reserve District in which Arkansas is located at the time of the contract purchase |
| Other States |
12% |
| Collection Fees |
In the event this account is placed in the hands of a Collection Agency or an attorney, for collection or suit instituted to collect same or any portion thereof, I and/or we agree and promise to pay any collection fees on the balance then due and owing. |
If there is any change in ownership, notification by certified mail is required. For opening orders less than $1,000 there will be a $15 Processing Fee required.
Signature of Officer________________________ Typed Name & Title___________________________
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