Northfield Electric Department Credit Reference (Page 2 of 2) in pdf

Northfield Electric Department Credit Reference Page 2

PAYMENT GUARANTEE BY ACTIVE CUSTOMER OF NORTHFIELD ELECTRIC

CUSTOMER NAME:___________________________________ACCOUNT #:_________________________

I, _________________________________________________, GUARANTEE PAYMENT, NOT TO EXCEED

$______________, FOR THE ABOVE PROSPECTIVE CUSTOMER________________________________,

FOR A PERIOD OF TWELVE (12) MONTHS. I UNDERSTAND ANY UNPAID BALANCE, NOT TO

EXCEED THE AMOUNT GUARANTEED ABOVE, BECOMES MY RESPONSIBILITY FOR PAYMENT

IF UNPAID BY THE ABOVE PARTY AT AN UNCOLLECTIBLE STATUS OF ACCOUNT. (GUARANTEE

MUST EQUAL THE DEPOSIT AMOUNT.) CANCELLATION, BY EITHER THE ELECTRIC

DEPARTMENT OR MYSELF, PRIOR TO THE END OF THIS PERIOD, REQUIRES A THIRTY (30) DAY

WRITTEN NOTIFICATION, COPIES OF WHICH WILL BE SENT TO THE GUARANTOR, AND THE

CUSTOMER FOR WHOM YOU ARE GUARANTEEING PAYMENT.

_________________________________________________________DATE____________________________

SIGNATURE OF CUSTOMER

OTHER CREDIT REFERENCES TO BE CONSIDERED:

NAME & ADDRESS OF REFERENCE:__________________________________________________________

NAME(S) ON ACCOUNT:_____________________________________________________________________

LENGTH OF SERVICE:__________________________ACCOUNT NOW ACTIVE______YES______NO

ACCOUNT STANDING: MONIES OWED AT PRESENT?:______YES______NO

IF YES, ON DELINQUENT STATUS? ______YES______NO

ANY DELINQUENT COLLECTIONS PAST YEAR? ______YES______NO

COMPLETED BY:________________________________________DATE:_____________________________

SIGNATURE

ADDITIONAL COMMENTS:__________________________________________________________________

THANK YOU FOR YOUR PROMPT ATTENTION TO THIS REQUEST. PLEASE FORWARD THE

COMPLETED CREDIT REFERENCE FORM TO NORTHFIELD ELECTRIC DEPARTMENT,

51 SOUTH MAIN STREET, NORTHFIELD, VERMONT 05663. PLEASE USE YOUR COMPANY

LETTERHEAD ENVELOPE.

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Northfield Electric Department Credit Reference Page 2