CREDIT APPLICATION
PLEASE PRINT
DATE __________________
COMPANY NAME __________________________________ TELEPHONE(
)_____________
ADDRESS ______________________________________________________________________
STREET CITY STATE ZIP
OWNER'S NAME_____________________________________ HOME PHONE _______________
HOME ADDRESS_________________________________________________________________
STREET CITY STATE ZIP
SSN or FEDERAL I D # ________________OCCUPATIONAL LICENSE #
_______________________
DATE BUSINESS STARTED ________________ HOW LONG IN BUSINESS_________________
ESTIMATED MONTHLY PURCHASE $____________
TYPE OF BUSINESS : ( ) INDIVIDUAL ACCT. ( ) SOLE PROPRIETORSHIP (
) PARTNERSHIP
( ) CORPORATION : INC. UNDER THE LAW OF _______________ ON
_______________
NAMES and TITLES OF ALL PROPRIETORS / PARTNERS / OFFICERS
NAME_______________________________________________ HOME PHONE _____________
HOME ADDRESS________________________________________________________________
STREET CITY STATE ZIP
NAME_______________________________________________ HOME PHONE _____________
HOME ADDRESS________________________________________________________________
STREET CITY STATE ZIP
NAME_______________________________________________ HOME PHONE _____________
HOME ADDRESS________________________________________________________________
STREET CITY STATE ZIP
REFERENCES
BUILDING OWNER :
NAME_____________________________________________ TELEPHONE(
)___________
ADDRESS______________________________________________________________________
STREET CITY STATE ZIP
BUSINESS REFERENCES :
NAME_____________________________________________ TELEPHONE(
)___________
ADDRESS______________________________________________________________________
STREET CITY STATE ZIP
NAME_____________________________________________ TELEPHONE(
)___________
ADDRESS______________________________________________________________________
STREET CITY STATE ZIP
NAME_____________________________________________ TELEPHONE(
)___________
ADDRESS______________________________________________________________________
STREET CITY STATE ZIP
BANK NAME / BRANCH___________________________ ACCOUNT # ____________________
ADDRESS_______________________________________CONTACT NAME________________
BANK PHONE #___________________________________FAX #_________________________
I HEREBY AUTHORIZE RELEASE OF CREDIT INFORMATION TO TERRY'S AUTO SUPPLY
FOR THE PURPOSE OF ESTABLISHING FURTHER CREDIT. I HAVE READ AND AGREE TO ALL OF
THE
TERMS AND CONDITIONS ON THE REVERSE SIDE. I HEREBY AGREE TO BE PERSONALLY LIABLE
FOR ALL THE DEBTS INCURRED BY APPLICANT PURSUANT TO THIS CREDIT APPLICATION.
SIGNATURE _____________________________________________ PRINT NAME
_______________________
AS AUTHORIZED AGENT & INDIVIDUALLY DATE
TERMS AND CONDITIONS CONTINUED ON BACK
TERMS AND CONDITIONS
The undersigned, individually and as an authorized agent for the applicant,
agrees that any credit extended shall be subject to the following terms and
conditions; which shall remain in full force and effect until cancelled by the
undersigned or the Applicant by letter to TERRY’S AUTO SUPPLY by certified mail,
return receipt requested.
1. The laws of the State of Florida shall be applicable to all disputes arising
under this credit application or as a result of any extensions of credit by
TERRY’S AUTO SUPPLY to the Applicant.
2. The undersigned and the Applicant agree to remit payment for any credit
extended at
any / all locations of business of TERRY’S AUTO SUPPLY, and it shall be
conclusively presumed that the failure to perform any such obligation shall give
jurisdiction to the courts of the State of Florida, and venue shall be in
Broward County, Florida.
3. All balances which remain unpaid for a period of thirty ( 30 ) days shall be
subject to a finance charge of 1 1/2% per month ( 18% per annum ) or the maximum
allowed by law, whichever is less..
4. In the event that TERRY’S AUTO SUPPLY must retain the services of an attorney
to effect the collection of any moneys owed, then the undersigned and the
Applicant agree to pay all costs incurred, including reasonable attorney's fees,
whether suit be brought or not. The parties agree that once this matter is
turned over to council for collection that no less than 25% of total claim shall
be deemed reasonable.
5. The Applicant agrees that any employee of Applicant signing any delivery
document provided by TERRY’S AUTO SUPPLY shall be deemed fully authorized on
behalf of Applicant.
6. TERRY’S AUTO SUPPLY may accept late payments, partial payments, or any check
or money order marked as being payment in full as being settlement in full of
any dispute without losing any rights hereunder or under law. Acceptance of such
payments shall not change these Terms and Conditions in any way.
7. The undersigned and the Applicant hereby waive the right to trial by jury in
any litigation arising from the extension of credit pursuant to this application
for credit between the parties. Further the undersigned and applicant waive all
homestead and exemption rights (particularly rights under Florida Statute
222.11(2)(b)).
8. Title to goods furnished to the Applicant pursuant hereto shall remain in
TERRY’S AUTO SUPPLY until said goods are paid in full. All payments on
Applicant's account shall be applied to the oldest unpaid charges appearing upon
the receivables ledger of TERRY’S AUTO SUPPLY with reference to Applicant's
account.
9. The undersigned agrees to keep the information contained in this Application
current and to immediately notify TERRY’S AUTO SUPPLY of all changes. The
undersigned applicant authorizes TERRY’S AUTO SUPPLY to secure such credit
reports as is deemed advisable.
10. Credit privileges may be revoked for failure to pay the balance due when
required, and may also be revoked for charges in excess of credit limit. Charges
in excess of credit limit allowed by TERRY’S AUTO SUPPLY shall not change these
Terms and Conditions.
11. These Terms and Conditions represent the entire contract between the
parties, and all parties agree to be bound by these Terms and Conditions. No
modification, addition to, or waiver hereof shall be effective unless agreed to
in writing by TERRY’S AUTO SUPPLY .
12. Sales of all special order goods or merchandise are final. TERRY’S AUTO
SUPPLY may authorize the return of stock goods in its sole discretion, subject
to a return charge.
13. Customer agrees that TERRY’S AUTO SUPPLY will not be bound to any term or
condition of any document that is part of Customer’s purchase order or buying
process.
14. Customer authorizes TERRY’S AUTO SUPPLY to furnish information about
Customer’s account to credit reporting agencies and other persons who may
lawfully receive information.
15. Cancellation of this agreement shall not effect the obligations of the
applicant and the person signing this agreement for previous unpaid obligations
of the customer. The person signing this agreement is cautioned that should
he/she leave the customer’s employ that he/she will remain obligated under this
agreement provided however, the signer may receive release from purchases made
after the signer’s termination from customer by written letter from TERRY’S AUTO
SUPPLY.
I HEREBY AUTHORIZE RELEASE OF CREDIT INFORMATION TO TERRY'S AUTO SUPPLY
FOR THE PURPOSE OF ESTABLISHING FURTHER CREDIT. I HAVE READ AND AGREE TO ALL OF
THE
ABOVE TERMS AND CONDITIONS. I HEREBY AGREE TO BE PERSONALLY LIABLE
FOR ALL THE DEBTS INCURRED BY APPLICANT PURSUANT TO THIS CREDIT APPLICATION.
SIGNATURE _____________________________________________ PRINT NAME
_______________________ ________
AS AUTHORIZED AGENT & INDIVIDUALLY DATE