Allergy Be Gone Credit Application

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CREDIT APPLICATION

Line of Credit Requested $

Date // (mm/dd/yy)

Business Name

Legal Name of Corp. (if different)

Phone ()

Fax ()

Billing Address for past years

Street

City

State

Zip Code

Shipping Address (if different)

Street

City

State

Zip Code

Former Business Address (if applicable)

Street

City

State

Zip Code

D&B (Duns & Bradstreet) #

Federal Tax ID

Who is the buyer?

Bookkeeper?

Type of Business

Date Established //
(mm/dd/yy)

How long are you in business?

years

Special Ordering Instructions

Will you pay sales tax?Yes No If No, please list sales tax exemption #

OWNERSHIP: Sole Owner Partnership Corporation

Principles:

Name	Title	S.S.#	Address
1)
2)
Trade References (Name of suppliers of major products and services): *Very important*

Name	Phone	Fax	Address & Account #
1)
2)
3)
4)
BANK REFERENCES: Checking Loan Savings

Bank Name	Phone	Fax	Contact & Account #
1)
2)
Has the firm or any of its Principals ever been bankrupt?Yes No If Yes, explain:
Applicant agrees to pay any collection costs incurred to collect the amount balance, including reasonable attorney fees. Applicant company will automatically access a 1.6% Finance Charge per month on all past due invoices.


Name	Title		Sign Below

			______________________________________

			______________________________________
Personal Guarantee
In consideration of credit being extended by Allergy Be Gone to the above named applicant for merchandise to be purchased, whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to Allergy Be Gone, the faithful payment, when due, of said purchases made within five years next after the date of this application. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on application, protest and notice to undersigned guarantor of dishonor or default by applicant or with respect to any security held by Allergy Be Gone, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned revocation of this guarantee shall be in writing and delivered to Allergy Be Gone 34 34th Street Unit 3, Brooklyn, NY 11232. The undersigned WILL/Will Not Submit a Financial Statement. THE UNDERSIGNED HAVE READ AND UNDERSTAND THIS CREDIT APPLICATION AND AGREE TO THE ABOVE TERMS AND CONDITIONS. THE UNDERSIGNED CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT. You are authorized to investigate the credit reference listed above.

Name	S.S.#		Sign Below

			______________________________________

			______________________________________

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Personal Guarantee