Credit Application

BILL TO:
Trade Name (DBA):   General Offices:
Legal Name: Street Address:
Mailing Address: P.O. Box:
City: State: Zip:
City: State: Zip:
Business Phone: ()-- ext Accounts Payable Contact:
Business Fax: ()-- General Office Phone: ()--
  General Office Fax: ()--

BUSINESS FACTS:
Federal Tax I.D. #:   Proprietorship  Corporation  Partnership  
Dun & Bradsheet #: DOT #:
Is business a subsidiary or franchise? Yes   No Operator owned premises? Yes   No
If Yes, please name:
Incorporated under state laws of   On what date?

COMPLETE THE FOLLOWING INFORMATION FOR TWO CORPORATE OFFICERS, PARTNERS, OR INDIVIDUAL PROPRIETOR
1)  Name & Title:   2)  Name & Title:
     Home Address:      Home Address:
     City, State, Zip:      City, State, Zip:
     Home Phone: ()--      Home Phone: ()--

BANK INFORMATION:
Bank Name:   Phone: ()--
Address: City:      State:
Bank Contact: Account Number(s):

TRADE REFERENCES:
NAME ADDRESS PHONE #
1. ()--
2. ()--
3. ()--
*List only those accounts that you have an established line of credit with. No personal references. No COD accounts.


AGREEMENT: Parties hereby agree that all purchases of goods and/or services from Midwest Systems are subject to the following terms and conditions:
  1. Once approved, this application constitutes a contract to conduct business between Midwest Systems (hereafter referred to as The Company) and the applicant.
  2. All amounts due for goods and services purchased from The Company are payable (in US Funds) at Midwest Systems, 5911 Hall Street, St. Louis, MO 63147.
  3. Terms are net 30 days, unless otherwise stipulated in writing and agreed to by all parties. If an amount due The Company is not paid within terms, a finance charge of 2% per month of the delinquent balance, or such rate allowable by law, may be added to the invoice amount, and will become due immediately.
  4. Should it become necessary, reasonable attorney’s fees, interest, and costs, associated with the collection of past due debts will be paid by the debtor.
  5. Goods and/or services purchased from The Company are not payable in installments.
RELEASE OF CREDIT INFORMATION. Applicant authorizes The Company to inquire into, and obtain from any bank, lending institution, or credit reference, whether listed on the Credit Application or not, any and all information relating to the applicant’s credit worthiness and/or financial condition.
APPLICABLE LAW. All Transactions arising hereunder shall be governed and interpreted by the laws of the State of Missouri..
Name of officer, owner or partner  
Title