Credit Application

Marine Supply

Company Name:

Date:

Billing Address:

City:

State:

Zip Code:

Shipping Address:

City:

State:

Zip Code:

Phone #:

E-Mail:

Fax #:

Type of Business:

Date Established:

Tax Exempt:

Tax Exempt #

Purchasing Contact:

Accounts Payable Contact:

Bank Name:

Bank Reference:

Phone #

Phone #

Acct. #

Contact Name:

Company Name:

Address:

City:

State:

Zip Code:

Phone #:

E-Mail:

Fax #:

Trade References:

Address:

City:

State:

Zip Code:

Phone #:

E-Mail:

Fax #:

Contact Name:

Company Name:

Address:

City:

State:

Zip Code:

Phone #:

E-Mail:

Fax #:

Contact Name:

Company Name:

Address:

City:

State:

Zip Code:

Phone #:

E-Mail:

Fax #:

Contact Name:

It is understood and agreed to that all charges are due and payable in full by the 30th day after invoice date (net 30 days after invoice date). Any account not paid according to the above terms of sale will become delinquent and be assessed a service charge of 1.5% per month, or 18% per annum, on past due balance. Applicant further agrees to pay any collection costs, including attorney's fees, required from debt collection arising from this account. Any account reflecting a past due balance may be closed.

 

I acknowledge and accept the above terms and authorize A2O Inc. to contact the references given herein and any other sources to secure sufficient information it deems necessary to consider this application. I further state that all data provided is correct and accurate.

Is all the above information correct?

Do you agree to the terms listed above?

Name of Applicant:

Position in Company: