Business Account Credit Application & Agreement

Tell us about your business

BUSINESS NAME:

ADDRESS:

CITY:

STATE:

ZIP:

PHONE:

EMAIL:

TYPE OF OWNERSHIP

PARTNERSHIP CORPORATION PROPRIETORSHIP LLC

ESTIMATE MONTHLY PURCHASES

YEAR BUSINESS STARTED

EIN

IF TAX EXEMPT - attach certificate

DO YOU ISSUE A PURCHASE ORDER

YES NO

PERSON TO CONTACT REGARDING ACCOUNT PAYABLE

AT PHONE

OWNERS AND/OR OFFICERS INFORMATION

NAME

TITLE

ADDRESS

CITY

STATE

ZIP

DATE OF BIRTH

COUNTY

Bank Information

NAME OF BANK

ADDRESS

PHONE

Major Business Trade References

NAME

PHONE

ADDRESS:

FAX

NAME

PHONE

ADDRESS:

FAX

NAME

PHONE

ADDRESS:

FAX

NAME

PHONE

ADDRESS:

FAX

AGREEMENT

Buyer authorizes all persons, institutions, organizations, companies and credit reporting agencies to furnish all pertinent information, including commercial and consumer credit reports, requested from time to time by United Roofing Supply (URS). The undersigned and Buyer, if different, each warrant that the information given is true and no unfavorable information has been omitted. The extension of credit hereunder, the amount of credit and the cancellation or reduction of credit shall be within the sole discretion of URS. Buyer agrees to be bound by URS’s Credit Agreement and Purchase Agreement and acknowledges receipt of same. Each undersigned individual who is either a partner of the Buyer as credit applicant or a sole proprietorship of the Buyer as credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the buyer, hereby consents for and authorizes URS to obtain and use consumer credit reports for each undersigned individual, from time to time as may be needed, to evaluate the credit of Buyer.

Sign here (acknowledges & agrees to be bound by attached terms & conditions)

SIGNATURE

DATE:

Your Personal Guaranty

Giving us your personal guaranty will speed the process of approving your application.

Continuing Guaranty

I (we) the undersigned understand that the information furnished you is for the purpose of obtaining credit from your company, that I am (we are) authorized, in my (our) capacity, to bind my (our) company accordingly. I (we) the undersigned, hereinafter referred to as guarantors, do jointly, severally, and unconditionally guarantee and promise to promptly pay when due any and all indebtedness of Buyer to URS, together with any late payment charge that may accrue thereon, regardless of how such indebtedness is incurred, whether such indebtedness is direct or indirect, absolute or contingent, due or to become due, or exists now or arises hereafter. In addition, the Guarantor(s) agree to pay all costs of collection, legal expenses and attorney’s fees paid or incurred by URS in the collection of Buyer’s indebtedness and in enforcing this Continuing Guaranty. The foregoing indebted- ness, principal, interest, costs, expenses and fees are hereinafter called the “Indebtedness.” Each undersigned guarantor agrees to be bound by URS’s Terms and Conditions of Continuing Guaranty.

Each undersigned personal guarantor, recognizing that his or her individual credit his- tory may be a necessary factor in the evaluation of this Continuing Guaranty, hereby consents for and authorizes URS to obtain and use consumer credit reports for each undersigned, from time to time as may be needed to evaluate the credit of Buyer and/or the undersigned.

Guarantors sign Here

Complete legal signature

First Name

Middle Name

Last Name

Home Address

City

State

ZIP

Phone

Signature

Complete legal signature

First Name

Middle Name

Last Name

Home Address

City

State

ZIP

Phone

Signature

CREDIT REPORT AUTHORIZATION FORM

By my signature below I,

Full Name:

Authorize

to obtain a Background Check and/ or Consumer Credit Report on me. This authorization is valid for purposes of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the Fair Credit Reporting Act (FCRA).

The Background Check may contain information available in the Public Domain but may not include interviews with persons other than previous employers or their agents.

By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This authorization shall be valid in original and copy form.

Applicant's Name:

Date of Birth:

Office use only

Credit Amount:

Terms:

Approved by:

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