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Credit
Application
Please
print out, complete & fax to 253-926-3161
Click
here for .PDF Format
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FIRM NAME :
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DATE
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CR. LIMIT APPROVED:
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MAILING ADDRESS:
CITY
STATE
ZIP
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FED ID#:
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CR. LIMIT REQUESTED:
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OFFICE ADDRESS:
CITY
STATE
ZIP
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PHONE:
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FAX:
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TYPE OF BUSINESS:
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(PLEASE
CIRCLE ONE)
ƒ
CORPORATION
ƒ PARTNERSHIP ƒ
SOLE
OWNER ƒ LLC
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E-MAIL ADDRESS:
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IN BUSINESS SINCE:
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(If
Partnership or sole Owner, please list individual social
security number in appropriate space below.)
NAMES OF OWNERS, PARTNERS OR OFFICERS & HOME ADDRESS:
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NAMES
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TITLE
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HOME
ADDRESS
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SOCIAL
SECURITY NO.
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IF
FIRM OR PRINCIPLE OF, OPERATED UNDER ANOTHER NAME PLEASE LIST
INFORMATION BELOW:
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HAS ANY PRINCIPLE OF THIS FIRM EVER FILED BANKRUPTCY?
ƒ YES
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NO
(If
yes, please state date of discharge ___________________)
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Pending litigation:
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YES
ƒ NO
EXPLAIN:
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IF BUSINESS IS BRANCH
OR SUBSIDIARY, PLEASE LIST HEADQUARTERS NAME, ADDRESS &
TELEPHONE NUMBER (IF
DIFFERENT THAN ABOVE):
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IF YOUR ACCOUNTS PAYABLE DEPT. IS NOT LOCAL PLEASE LIST BILLING
ADDRESS, NAME OF MANAGER & TELEPHONE NUMBER;
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CONTRACTOR’S LICENSE MUNICIPALITY LIC. NO.
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PLEASE LIST ANY SUGGESTIONS FOR BILLING THAT MAY EXPEDITE PAYMENT.
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STATE LICENCE NO.:
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BONDING INFORMATION (IF NOT
LOCAL GIVE ADDRESS)
TYPE
OF BOND: ___________________________________________________________-
INSURANCE AGENCY OR BROKER: _________________________________________________
BONDING CO, NAME:
_____________________________________________
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CREDIT REFERENCES
NAME
ADDRESS
PHONE/FAX #’S
ACCT#
CONTACT
NAME
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NAME OF BANK:
BRANCH:
ACCT#:
PHONE#:
CONTACT:
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THE APPLICANT HEREBY AUTHORIZES THE CREDITOR TO CONTACT THE ABOVE
FINANCIAL AND TRADE REFERENCES AND AUTHORIZES THE LISTED HERIN
TO RELEASE ALL INFORMATION REQUESTED.
IT IS UNDERSTOOD THAT ALL INFORMATION WILL BE KEPT
STRICTLY CONFIDENTIAL.
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PLEASE READ AND SIGN
NEXT
PAGE
OF THIS FORM
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Page 2
For and in consideration of credit
extended by Pacific Alaska Freightways, the undersigned hereby
guaranties the full and timely payment of this account, including
any service charges that may be incurred (not to exceed 1.5% per
month or fraction thereof applicable on the unpaid balance) and/or
legal fees if signing in a representative capacity of a principle,
partnership, corporation, or otherwise. Should credit availability be granted by seller/creditor, all
credit shall be extended at the discretion of the creditor.
Creditor may increase, decrease, or terminate any credit
availability at any time within its sole discretion.
If credit is extended by Pacific Alaska Freightways, no
payment will be recquired at the time of delivery.
Freight bills are due 30 days after the invoice date.
A written statement setting forth the unpaid principal
balances will be furnished on or about the first day of succeeding
calendar month. In the
event that the entire account balance is not paid on or by the net
due date as shown on each invoice, at the option of Pacific Alaska
Freightways, may be declared to be delinquent.
In the event that Pacific Alaska Freightways retains legal
counsel to assist it in collecting a delinquent account, the
undersigned promises and agrees to pay all reasonable legal costs
and attorney’s fees as well as collection fees if turned to an
outside agency actually incurred by Pacific Alaska Freightways.
The terms and conditions of this application shall, upon
extension of credit by the company, constitute an agreement of
sales.
Pacific Alaska Freightways reserves the right to retain
shipments in its possession until charges due on these shipments and
on prior shipments are paid in full.
Consignees are hereby placed on notice that their goods may
be held until both the freight charges on the particular shipments,
as well as any prior debts of the consignor, consignee, or party
liable to pay the freight bill, are paid in full, even though these
debts may arise from shipments to persons wholly unrelated to the
consignee. Pacific
Alaska Forwarder’s right to retain a current shipment for payment
of charges due on a prior shipment is a “Cross-Over lien.”
Venue shall be in Pierce County, Washington State.
Any sales that result from an extension of credit by seller
shall be construed under the laws of Washington and any lawsuit
resulting from this extension of credit may be commenced in the
State of Washington. The parties hereto knowingly and intentionally waive the
right to a jury trial on any issue or dispute that may arise between
them.
The undersigned hereby consent(s) to
Pacific Alaska Forwarder’s use of a non-business, consumer credit
report on the undersigned in order to further evaluate the
creditworthiness of the undersigned as principal(s), proprietor(s)
and/or guarantor(s) in connection with the extension of business
credit as contemplated by this credit application.
The undersigned hereby authorize(s) Pacific Alaska Freightways
to utilize a consumer credit report on the undersigned from time to
time in connection with the extension and continuation of the
business credit represented by this credit application.
The undersigned as {an} individual(s) hereby knowingly
consent to the use of such credit report consistent with the Federal
Fair Credit Reporting Act as contained in 15 U.S.C. @1681 et seq.
I/we hereby certify that the information given is true and
has been given for the extension of credit for business purposes.
Signed by:_________________________
Signed by:_________________________
Signed by:_____________________________
Print name:________________________
Print name:________________________
Print name:_____________________________
Title:_____________________________
Title:_____________________________
Title:__________________________________
Date:_____________________________
Date:______________________________
Date:__________________________________
For (Company Name):
_____________________________________________________________________________
The undersigned individual(s) in consideration of the
company’s extension of credit to the applicant hereby agrees to
personally guarantee any and all obligations of the applicant and
the company. This
guaranty shall be continuing and unlimited and may be terminated
only on 30 days’ written notice to Pacific Alaska Freightways. The company may exercise its rights under this guaranty
without first taking any action against the applicant.
The undersigned waives notice of default and non-payment, and
consents to the extension or modification of credit terms to the
applicant without notice.
Dated
Witness
Guarantor
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