Citation Support, Inc. - Application for Credit

DATE____________________

SHOULD YOU WISH TO ESTABLISH AN ACCOUNT AND LINE OF CREDIT, WE WILL NEED THE FOLLOWING INFORMATION. ALLOW THIRTY DAYS TO PROCESS THIS INFORMATION AS CREDIT INFORMATION MUST BE HANDLED BY MAIL. UNTIL YOUR CREDIT APPLICATION IS APPROVED, ALL RENTALS ARE C.O.D. YOU MAY USE CASH, CHECK, AMERICAN EXPRESS, VISA, MASTERCARD. EVEN THOUGH YOU MAY NOT WISH TO HAVE AN OPEN ACCOUNT, THE FOLLOWING INFORMATION MUST BE COMPLETED FOR OUR RECORDS.

COMPANY NAME:
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ADDRESS:
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MAILING ADDRESS (IF DIFFERENT):
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CITY, STATE & ZIP:
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PHONE:
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FAX:
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NATURE OF BUSINESS:
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CORPORATION______
PARTNERSHIP______
SOLE PROPRIETOR______
DATE OF INCORPORATION__________________

NAMES AND TITLES OF OWNERS, PARTNERS OR OFFICERS:
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HAVE YOU EVER FILED BANKRUPTCY? YES___ NO___
WHO IS RESPONSIBLE FOR ACCOUNTS PAYABLE?:
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NAME AND ADDRESS OF THREE PRINCIPAL SUPPLIERS ALLIED TO THE INDUSTRY WITH WHOM YOU HAVE AN OPEN ACCOUNT (NOT CREDIT CARDS)

1. NAME (PLEASE PRINT):
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ADDRESS:
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PHONE:
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ACCT#:
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2. NAME (PLEASE PRINT):
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ADDRESS:
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PHONE:
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ACCT#:
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3. NAME (PLEASE PRINT):
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ADDRESS:
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PHONE:
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ACCT#:
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BANK REFERENCE:
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PLEASE INDICATE THOSE ITEMS YOU REQUIRE TO APPEAR ON OUR INVOICE:
P.O.#__________
JOB#__________
JOB NAME__________
AUTHORIZED SIGNATURE:
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I PRESENT THIS APPLICATION TRULY AND CORRECTLY STATED TO THE BEST OF MY KNOWLEDGE AND FOR THE SOLE PURPOSE OF OBTAINING CREDIT FROM CITATION SUPPORT, INC. I AUTHORIZE YOU TO CHECK MY CREDIT HISTORY WITH THE CREDIT REFERENCES THAT I HAVE SUBMITTED ON THIS APPLICATION. IF INCORPORATED,
AN OFFICER MUST SIGN. IF A SOLE PROPRIETORSHIP, THE OWNER MUST SIGN. IF A PARTNERSHIP, ALL PARTNERS MUST SIGN.

NAME (PLEASE PRINT):
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SIGNATURE:
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TITLE:
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DATE:
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INSURANCE
CITATION REQUIRES A CERTIFICATE OF INSURANCE TO COVER THE VALUE OF THE EQUIPMENT FOR CASUALTY DAMAGE OR LOSS NAMING CITATION AS LOSS PAYEE AND ADDITIONAL INSURED. THE CERTIFICATE MUST BE ISSUED FOR $1,000,000 LIABILITY COVERAGE AND SPECIFICALLY COVER ALL LIABILITIES INCURRED BY THE USE AND OPERATION OF THE EQUIPMENT AND THE PERSONNEL UNDER THE CONTROL OF THE RENTEE. IT ALSO SHALL INDEMNIFY AND HOLD CITATION HARMLESS FROM ANY AND ALL EXPENSES, DAMAGES AND LIABILITIES. THIS CERTIFICATE OF INSURANCE MUST BE AN ORIGINAL. CITATION RESERVES THE RIGHT OF ACCEPTANCE OF THE POLICY CONTENT. IF YOU DO NOT HAVE INSURANCE, CITATION WILL PROVIDE YOU WITH COVERAGE FOR AN ADDITIONAL CHARGE.

INSURANCE BROKER:
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ADDRESS:
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PHONE:
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CONTACT:
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TERMS OF CREDIT
APPLICANT(S) AGREE TO PAY ALL MONIES DUE ACCORDING TO THE GRANTOR’S TERMS OF CREDIT. SHOULD APPLICANT DEFAULT ON TERMS AND IT IS NECESSARY TO INITIATE COLLECTION PROCEEDINGS, THE APPLICANT(S) AGREE TO PAY ALL COLLECTION EXPENSES INCLUDING COURT COSTS AND ATTORNEY FEES. PAYMENT IN FULL FOR EACH INVOICE IS DUE THIRTY (30) DAYS FROM THE DATE OF INVOICE, AND BECOMES DELINQUENT ON THE THIRTY-FIRST (31) DAY; AND WILL INCUR A TWO (2%) PERCENT FINANCE CHARGE ON THE AMOUNT OF INVOICE EACH THIRTY (30) DAY PERIOD INVOICE IS UNPAID. IF PAYMENT OF THE AMOUNT IS NOT RECEIVED IN ACCORD WITH AGREED CREDIT TERMS, IT WILL CONSTITUTE A DELINQUENT INDEBTEDNESS AND WILL BE CAUSE FOR REVOCATION OF CREDIT AND/OR WHATEVER OTHER REASONABLE MEASURES THAT THE GRANTOR SHALL DEEM NECESSARY. NO CREDIT WILL BE GRANTED PRIOR TO RECEIPT OF A SIGNED CREDIT APPLICATION. WE HAVE READ AND UNDERSTAND THE ABOVE CREDIT TERMS AND AGREE TO ABIDE BY THEM.

NAME (PLEASE PRINT):
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SIGNATURE:
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TITLE:
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DATE:
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NAME (PLEASE PRINT):
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SIGNATURE:
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TITLE:
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DATE:
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AGREEMENT
WE HEREIN MAKE APPLICATION FOR CREDIT. IF CREDIT IS GRANTED, WE PROMISE TO PAY ALL INVOICES WITH ACCORDANCE TO TERMS OF CREDIT. WE JOINTLY AND SEVERALLY CERTIFY THAT THE STATEMENTS MADE HERE ARE AN ACCURATE REFLECTION OF THE CONDITION OF THE BUSINESS, AND JOINTLY AND SEVERALLY PERSONALLY GUARANTEE PAYMENT OF ANY AMOUNTS DUE AND OWING BY THE APPLICANTS OF THE BUSINESS FOR GOODS PREVIOUSLY DELIVERED OR TO BE DELIVERED TO THE APPLICANT OR TO THE ABOVE TRADE NAME. THIS GUARANTOR SHALL BE RESPONSIBLE FOR ALL BILLING COST AND COST OF COLLECTION INCLUDING ATTORNEY FEES INCURRED IN THE COLLECTION OF UNPAID BALANCES. GUARANTOR SHALL BE DEEMED PRIMARILY LIABLE FOR THE DEBT HEREIN AND MAY BE NAMED INDIVIDUALLY AND/OR JOINTLY WITH ANY OTHER PARTIES RESPONSIBLE FOR THE SUMS AS REFERENCED HEREIN. WE WILL PERSONALLY NOTIFY THE GRANTOR IN WRITING IF THERE IS ANY MAJOR CHANGE IN THE MANAGEMENT OF FINANCIAL CONDITION OF THE FIRM. WE GIVE OUR PERMISSION TO CITATION SUPPORT, INC. AND/OR ITS AGENTS TO VERIFY AND/OR SUPPLEMENT THE INFORMATION STATED HEREIN.

TO BE SIGNED BY OWNERS, PARTNERS OR OFFICERS LISTED - NOT AN EMPLOYEE.