IDA Credit Application

Note: In order to open an account, please have a principle of the company fill out the credit application enclosed. We will not check the personal credit of the guarantor; it is simply used as an instrument of collection in the event of default. A credit account will make things that much more convenient for your employees and drivers.

Click here to download the Microsoft Word version: IDA Credit Application

Click here to download the Adobe Acrobat version: IDA Credit Application

IDA CREDIT APPLICATION

Business Name:___________________________________________________________

Billing Address:_________________________________________________________

City, State, Zip:_____________________________________________________________

Telephone Number:__________________________ Fax Number:____________________________

Type of Ownership: Corporation______ LLC______ Partnership______ Limited Partnership_______

Sole Proprietorship______ Other______

Type of Business:_______________________________________ Date Started:________________

Federal Tax I.D. #:______________________________________

Owners, Members, Partners and/or Officers:
Name                                Home Address                  Title                      Home Phone                  SS#
________________________________________________________________

________________________________________________________________

________________________________________________________________

Bank References:

Bank:_______________________ Address:_____________________________________________

Phone:_____________________________ Officer to Contact:_______________________________

Checking Account #:__________________________ Savings Account #:______________________

Trade References Required:
Company                        Address                            Contact Person                              Phone

________________________________________________________________
________________________________________________________________
________________________________________________________________

Amount of credit requested per month $__________________________

TERMS & CONDITIONS OF OPEN ACCOUNT
(Please Read Carefully)

I certify, that the above statements (which are furnished for the purpose of obtaining credit) are true and correct. The client agrees to pay collection fees, court costs and/or attorney’s fees, with interest if third party collection is necessary. The undersigned warrants that he/she has authority to execute this Credit Application and to bind said company to the terms contained herein. I/We understand, acknowledge, and accept Industrial Drug & Alcohol’s terms of sale are net 15 and agree to make full payment within these terms. I/We hereby authorize you or your agent/representative to secure a credit report and agree to the release of credit information. This authorization shall be continuing without expiration and a photocopy or fax copy shall be given the same effect as the original.

Dated this________ day of_____________ , 200___

Company Name___________________________________________________________

Signed_______________________________________ Title________________________________

Print Name_______________________________________

A “Personal Guarantee” and/or “Personal Credit Report” may be required if the applicant does not meet the credit guidelines of the IDA.

“PERSONAL GUARANTEE”

In consideration of IDA extending credit to __________________________________and its related entities (hereinafter collectively referred to as “IDA”). We the undersigned, hereby Unconditionally Guarantee the prompt performance of the duties and obligations set forth in the above agreement and payment to IDA, it’s successors, and assigns, on all amounts not paid within 15 days after due date, both before and after judgment, and all costs of collection and attorney fees with interest in the event of default. Liability of the undersigned shall not be affected or prejudiced by the additional acceptance of a note or other evidence of indebtedness, the extension of time for payment, payment arrangements, or other indulgence granted to client, or by agreement affecting said indebtedness, and the undersigned hereby waives notice of any or all of the aforesaid. The filing of suit or exhaustion of collection or legal remedies against client shall not be a condition precedent to the enforcement of this guarantee and the undersigned hereby expressly waives presentment for payment demand, protest, and notice of protest or diligence. This guarantee shall be a continuing guarantee.

I/We hereby authorize you or your agent/representative to secure a credit report and agree to the release of credit information. This authorization shall be continuing without expiration and a photocopy or fax copy shall be given the same effect as the original.

Signature:____________________________________Date:___________SS#:______________

Signature:____________________________________Date:___________SS#:______________

“AUTHORIZATION TO OBTAIN PERSONAL CREDIT REPORT/HISTORY”

The undersigned hereby consent(s) to IDA’s use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), member(s), partner(s), proprietor(s) and/or guarantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize(s) IDA to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as (an) individual(s) hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. @ 1681 et seq.

Signature:____________________________________Date:___________SS#:______________

Signature:____________________________________Date:___________SS#:______________