Sales/Territory #________ Credit Requested $________

 

Unicoa Industrial Supply

 

2224 N. 23rd Ave.  Phoenix, AZ 85009

 

Ph. 602-254-4666  Fax 602-254-7100

 

Company

Name ___________________________________________________________Phone#____________________

 

Billing Address____________________________________________________Fax#_____________________

 

City_____________________________________State___________Zip______________

 

                             

 

Type of Business_________________________Yrs. In Bus.___________ Yrs. @ This Address _____________

 

Federal Tax ID #_________________________State Tax #_________________________Expires___________

 

Contractor Lic. #_________________________Resale Exempt (must attach copy)________________________

 

Ship To Address___________________________________________________Phone #___________________

    (If different from mailing/billing address)

 

City____________________________________State_____________Zip______________

 

                                               

 

Name___________________________Title______________Address__________________________________

 

Name___________________________Title______________Address__________________________________

 

Accounts Payable Contact_____________________________________Phone#/Ext.______________________

 

Do You Require Purchase Orders?                  

 

 

AGREEMENT

 

                In consideration of, and in order to induce you to establish a line of credit based on the foregoing application, I/We authorize the creditor herein or it’s agent to obtain any information you consider necessary from any source, including banks, regarding the statement(s) in this application.

                I/We further understand unless a credit amount has been approved, all goods and services must be paid for at the time of deliver.  The Company Credit Department reserves the right to approve or disapprove credit when it deems appropriate.

                In addition, I/We promise to pay all bills when rendered within the specified terms of the invoice.  Failure to make timely payment will result in a default of the open account agreement and interest computed at the legal rate of 1.5% per month (18%APR) will be assessed on the unpaid balance or any portion thereon. 

                I/We agree that my credit line is subject to periodic review and shipments may be held if the account is delinquent or exceeds the established credit line. 

 

SIGNED_________________________________________PRINT NAME_____________________________

 

TITLE__________________________________________DATE_____________________________________

 

 

TRADE REFERENCES

 

Vendor___________________________________Acct#_______________Phone#_______________________

 

Contact___________________________________State________________Fax#_________________________

 

Vendor___________________________________Acct#_______________Phone#_______________________

 

Contact___________________________________State________________Fax#_________________________

 

Vendor___________________________________Acct#_______________Phone#_______________________

 

Contact___________________________________State________________Fax#_________________________

 

 

FINANCIAL

 

Bank________________________________Branch________________Contact__________________________

 

Phone#_________________________Fax#_________________________Account#______________________

 

 

 

 

PERSONAL GUARANTEE

 

                In consideration for Glendale Industrial Supply, L.L.C. dba Unicoa Industrial Supply extending credit to the business/individual identified below for any materials and/or services after this date at the request of the applicants of its agents, the undersigned individual personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Glendale Industrial Supply, L.L.C. dba Unicoa Industrial Supply by the business/individual below, whether said sums are due under open account, contract, or otherwise.

 

                It is further understood that credit, if extended, is to be on a continuing basis, and may exceed estimated maximum credit limit required as stated in the credit agreement between Glendale Industrial Supply, L.L.C. dba Unicoa Industrial Supply and _______________________________________(company name).

 

                This guaranty shall be continuing and irrevocable.

 

                                                                                                                DATE__________________________________

 

 

Guarantor’s Signature________________________________Print Name_______________________________

 

Witness’s Signature_________________

 

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