Open Account Application

OPEN ACCOUNT APPLICATION REQUEST

Basic Information
Company Name*
Contact Person*
Date of Application*
MM slash DD slash YYYY
Phone*
Purchaser Email*
Fax
Website
Billing Address
Full Billing Address (no abbreviations, please)*
Shipping Address 1
- Same as Billing Address
Full Shipping Address 1 (no abbreviations please)*
More than one Ship-To address can be associated with your account. Please provide ALL addresses you need added to your account.
Shipping Address 2
Full Shipping Address 2 (no abbreviations please)
Shipping Options
Email For Shipping Confirmation*
Default Shipping Method*
Shipping Terms*
Do You Allow Split Shipments?*
Do You Allow Backorders?*
Receipt Method For Invoices & Statements*
Would you like to use website to place your orders?*
AP Contact
Full Name*
Email*
Phone*
Bank Reference
Bank*
Branch*
Account #*
Contact*
Phone*
Company History
Date Established*
MM slash DD slash YYYY
D&B#*
Federal Tax ID*
Ownership*
List names of officers, partners or owners
Officer, Partner or Owner 1*
Officer, Partner or Owner 2*
Officer, Partner or Owner 3*
Officer, Partner or Owner 4*
Credit References
Reference 1
Company Name*
Contact Full Name*
Account #*
Phone*
Reference 2
Company Name*
Contact Full Name*
Account #*
Phone*
Reference 3
Company Name*
Contact Full Name*
Account #*
Phone*
In consideration of granting payment terms by Chef Rubber to applicant, applicant agrees to the following terms and conditions:

1. If the credit references listed require correspondence in writing, this may delay approval of applicant’s credit application. 2. Applicant agrees to pay all charges in accordance with the terms of sale as specified on the invoice and further agrees that any past due balance will be subject to 2% monthly (annual % rate of 24%) service charge on any unpaid portion. Delinquent collection costs are the responsibility of the undersigned and a representative thereof. 3. All invoices must be paid in full when due. All accounts are placed on a prepaid basis when becoming 60 days past due. If an acount becomes 90 days past due, the account is placed on a prepaid basis. 4. Applicant expressly agrees that any dispute related to this application, applicant’s failure to pay any amounts when due and owing, and any dispute related between applicant and Chef Rubber shall be filed in the superior court of Las Vegas, Nevada, and that Nevada law shall apply to any dispute, claim or lawsuit. The prevailing party to any legal action related to this credit application and/or applicant’s failure to pay any amounts when due and owing shall be entitled to any and all costs and attorney fees related to such legal action.
I*
agree that the above information is for the purpose of obtaining payment terms and is warranted to be true, and have read and agree to honor the terms and conditions stated above.
Signature hereby authorizes credit investigation
Signed*
Dated*
MM slash DD slash YYYY