Credit Application Form (U.S.) FOR U.S. APPLICANTS Step 1 of 6 - Company Information 16% Company InformationName(Registered corporate name)Business phone #Cell phone #Email How long in businessWebsite Type of companySelect typeFirst ChoiceSecond ChoiceThird ChoiceStreet addressCityProvinceSelect ProvinceFirst ChoiceSecond ChoiceThird ChoicePostal code Principals / OwnersPrincipal / OwnerFirst nameMiddle initialLast nameDate of birth YYYY dash MM dash DD Home phone #Driver's licence #Street addressCityProvinceSelect provinceFirst ChoiceSecond ChoiceThird ChoicePostal codePrincipal / Owner 2First nameMiddle initialLast nameDate of birth YYYY dash MM dash DD Home phone #Driver's licence #Street addressCityProvinceSelect provinceFirst ChoiceSecond ChoiceThird ChoicePostal codeADD ANOTHER Principal / Owner ADD ANOTHER Principal / Owner Banking InformationBank nameBranch addressPhone #Bank contact personAccount No.Date account opened YYYY dash MM dash DD Trade References / Suppliers1. TRADE ReferenceName(Registered corporate name)AddressEmail Phone #No toll-free numbersCityProvinceSelect provinceFirst ChoiceSecond ChoiceThird ChoicePostal code2. TRADE ReferenceName(Registered corporate name)AddressEmail Phone #No toll-free numbersCityProvinceSelect provinceFirst ChoiceSecond ChoiceThird ChoicePostal code3. TRADE ReferenceName(Registered corporate name)AddressEmail Phone #No toll-free numbersCityProvinceSelect provinceFirst ChoiceSecond ChoiceThird ChoicePostal code Other Information RequiredCredit limit requestedAre purchase orders required?SelectFirst ChoiceSecond ChoiceThird ChoiceCredit limit requestedAre purchase orders required?SelectFirst ChoiceSecond ChoiceThird ChoiceFederal I.D. # Terms & Conditions The undersigned hereby grants authority and directs the financial institution(s), and trade creditors named on the front page to release any and all information requested by Buchner Manufacturing Inc. or any other searches or inquiries we deem necessary. The undersigned hereby authorizes Buchner Manufacturing Inc. to obtain personal and company credit reports from credit reporting agencies of its choice from time to time as required. The Personal Guarantee is a separate document but constitutes an integral part of granting credit to the Applicant. Terms are net 30 unless otherwise advised. A service charge of 2% per month (24% per annum) will apply on the amount of any overdue account from the date such account becomes overdue. Accounts unpaid after 30 days from invoice date shall be considered overdue. All returned cheques are subject to a $25.00 administration fee and service will be disrupted until the subject cheque has been cleared. Accounts over the pre-arranged credit limits and which are also delinquent are put “on hold” until arrangements have been made to have the account returned to good standing. All returns are subject to authorization by Buchner’s head office within 7 days of receiving the product and subject to a 20% restocking charge unless defective. All damaged goods must be noted immediately on packing slip or bill of lading upon receipt of materials and product must be available for inspection. Goods cannot be disposed of without authorization from Buchner Manufacturing Inc. Failure to do so will forfeit claim. Items ordered outside of normal stock are not returnable. Warranties are subject to the approval of the original manufacturer/supplier. Any claims are limited to the original invoice value and cover material only. Buchner Manufacturing Inc. is in no way responsible for forming, shaping or installation which occurs outside of their facilities. This is the responsibility of the distributor, dealer, contractor or applicator. The Applicants agree to notify Buchner Manufacturing Inc. promptly and in writing of changes in any of the following information: business name, ownership, address, banking information or other information regarding the company structure. AGREEMENT(Required) I/we have read and understood the above terms and hereby agree to abide by these terms and conditions, and I am authorized to bind the applicant to this legal commitment.1. SIGNATURE(Required)Signature of authorized representative 2. SIGNATURE(Required)Signature of authorized representative
