Business Credit Application Form
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1FOX BUSINESS SYSTEMS - 531 Fort Riley Blvd., Manhattan, KS 66502
B u s i n e s s C r e d i t A p p l i c a t i o n
Billing Information
Full Legal Name
_
Business Tel. #
_
_
Fax #
_
__
Street Address
_ _ City
__
State
Zip
Shipping Address (If Different)
__
City
_ _
State
Zip
How long have you been in business?
Type of business
__
_ _
Annual Sales Volume
_
Estimated Yearly Purchases
_
_ _
Business Credit Application
Principal Authorizes Officer
_
Title(s)
_
__
_
Contact Person(s)
_
Duns Number
_
___
Name of Parent Company
__
_ __
Street Address
City
_ _
State
_
Zip
_ _
Bank Reference
Bank Name
_
Contact
_ _
Account#
__
Bank Address
City
_ __
State
Zip
__ _
Telephone Number
_
Fax Number
_
_ _
Trade References
1) Name
_
Acct.#
_
Contact
__
___
Addr.
City
_ _
State _ Zip
Tel.
_
_
__
2) Name
_
Acct.#
_
Contact
___
__
Addr.
City
_ _
State
_ Zip
Tel.
_
_ __
3) Name
_
Acct.#
_
Contact
___
__
Addr.
City
_ _
State
_ Zip
Tel. _
_ __
THE UNDERSIGNED, BY THE EXECUTION OF THIS CREDIT APPLICATION, AGREES THAT IT SHALL PAY FOR ALL OUTSTANDING BALANCES PER TERMS
AS AGREED BETWEEN BOTH PARTIES. IN THE EVENT THIS ACCOUNT IS REFERRED TO ANY ATTORNEY FOR COLLECTION, THE PARTIES AGREE THAT
AN ADDITIONAL TWENTY-FIVE (25%) OF THE OUTSTANDING BALANCE DUE WILL BE PAID AS ATTORNEY'S FEES.
Auth. Signature
(Print Name)
Title
___
Date
INDIVIDUAL PERSONAL GUARANTEE
I, (NAME)_____________________________________ RESIDING AT (ADDRESS)________________________________________ FOR AND IN CONSIDERATION OF YOUR
EXTENDING CREDIT AT MY REQUEST TO (COMPANY)______________________________________________________ (HEREINAFTER REFERRED
TO AS THE "COMPANY"), OF WHICH I AM (TITLE)_____________________________________, HEREBY PERSONALLY GUARANTEE TO YOU THE PAYMENT AT FOX BUSINESS
SYSTEMS . IN THE STATE OF KANSAS ANY OBLIGATION OF THE COMPANY AND I HEREBY AGREE TO BIND
MYSELF TO PAY YOU ON DEMAND ANY SUM WHICH MAY BECOME DUE TO YOU BY THE COMPANY WHENEVER THE COMPANY SHALL FAIL TO PAY THE SAME. IT IS
UNDERSTOOD THAT THIS GUARANTEE SHALL BE A CONTINUING AND IRREVOCABLE GUARANTEE AND INDEMNITY FOR SUCH INDEBTEDNESS OF THE COMPANY. I DO HEREBY
WAIVE NOTICE DEFAULT, NON-PAYMENT AND NOTICE HEREOF AND CONSENT TO ANY MODIFICATION OF RENEWAL OF CREDIT AGREEMENT HEREBY GUARANTEE.
Auth. Signature
(Print Name)
Title
___
Date
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Parent category: Business