Firm Name:________________________________________ Date:___/___/___
BDA:__________________ Phone: (____)___________ Fax: (____)___________
Mailing Address:___________________ Street Address:_____________________
City:____________________ State:________________ Zip:__________________
How Long In Business?________ How long in present location?______________
Type of Business: [] Proprietorship []Partnership []Corporation State inc.________
Name of Owner, Partners or Officers:___________________________________
Type Of Business:_________________ Have you ever Declared Bankruptcy:____
Is your Business Operational Year Round? ______ if no, Specify:______________
Bank References:________________________ Branch:_____________________
Name of Banker:_________________________ Phone: (____)_______________
Address:____________________ City
& State:________________ Zip:_________
Four Trade References where you purchase on Open Account:
1.)Name:_______________ Phone: (____)___________
Fax: (____)___________
Address:_____________
City & State: ____________ Zip:________________
2.)Name:_______________ Phone: (____)___________
Fax: (____)___________
Address:_____________
City & State: ____________ Zip:________________
3.)Name:_______________ Phone: (____)___________
Fax: (____)___________
Address:_____________
City & State: ____________ Zip:________________
4.)Name:_______________ Phone: (____)___________
Fax: (____)___________
Address:_____________
City & State: ____________ Zip:________________
1.)All sales subject to approval by sales manager and credit manager.Upon approval of credit, we agree that all merchandise ordered and shipped to us constitutes a binding agreement and that we are liable for any collection fees, attorney fees, court fees, court costs, finance charges incurred for non-payment when ordered by our authorized agent.2.)A finance charge of 1-1/2% per month will be assessed on all past
due amounts and all deferred charges will become immediately due
and payable.3.)Payment is due as specified on the individual invoice.
4.)This contract is entered into and all payments thereunder are payable
to St. Charles City of St. Charles, Missouri, and enforced thereof hall
be in The City of St. Charles County, Missouri.5.)Under no circumstances will consignment orders be considered.
6.)Prices and conditions of sale subject to change without notice.
Signed:________________________ Title:________________ Date:___/___/___