Client Information Sheet
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3CLIENT INFORMATION SHEET
J. B. PARKS WHOLESALE FLORIST INC.
3510 ROSS AVE, DALLAS, TEXAS 75204
PHONE # 214-821-1488
FAX # 214-821-6460
DATE: ______________
NAME OF BUSINESS: ______________________________________________________________________
ADDRESS:_________________________________________________________________________________
CITY:________________________________STATE________________ZIP_________COUNTY_________
Business Phone # ________________________________ Business Fax # ______________________________
NAME OF OWNER:
(1) ___________________________________Home #_________________________
(1) RESIDENT ADDRESS: _________________________ CITY: ________________ ZIP: ______________
DL# ________________ M/F: ___ HAIR COLOR: _______ DATE OF BIRTH: ____/________/________
SOCIAL SECURITY #_________-__________-_____________
EMAIL ADDRESS:_________________________________________________________________________
NAME OF CO-OWNER OR PARTNER:
_______________________________________________
(2) RESIDENT ADDRESS: _________________________ CITY: ________________ ZIP: ______________
DL# ________________ M/F: ___ HAIR COLOR: _______ DATE OF BIRTH: ____/________/________
SOCIAL SECURITY #_________-__________-_____________Home # ______________________________
EMAIL ADDRESS:_________________________________________________________________________
HOW DID YOU HEAR ABOUT US?_______________________WEBSITE:__________________________
DATE YOU STARTED BUSINESS: ____/_____/__________ Business Property Owned? ___YES ___ NO
BUSINESS INCORPORATED: _____YES _____ NO
BANK _____________________________________ ACCOUNT # : _________________________________
ACTIVE CHARGE ACCOUNT: ______________________________________________________________
TAX EXEMPT #: ___________________________ TEXAS AGRICULTURAL #: _____________________
CREDIT ACCEPTANCE FORM
For and in consideration of J B Parks Wholesale Florist, Inc. (known as, hereinafter referred to as “Parks”) extending check-
cashing privileges to ________________________________________ (known as, hereinafter referred to as the “company”), the
undersigned (whether one or more), jointly, severally and unconditionally guarantees all checks presented from said company
plus reasonable handling charges. This guarantee additionally binds the undersigned to pay any attorney or collection fees, court
costs assessed by a court or paid by Parks should the account be placed with an attorney or agency for collection. The
undersigned further agrees to resolve all disputes for payment in Dallas County, Texas subject to, and interpreted in accordance
with, the laws of the State of Texas. I agree to provide written notification at least ten (10) days in advance to Parks of any intent
to sell this company. If notification is not provided, I will continue to be primarily responsible for any indebtedness of the
company. In addition, if any unpaid invoices are due, for any reason, I understand that I will be personally responsible. Full
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payment due 10
of the month following the month of purchase. A finance charge on the past due balance will be incurred if bill
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is not paid by the 10
of the second month following the purchase. The finance charge is 18% per year, or 1 ½% per month. I/we
further authorize Parks to investigate the company’s and the undersigned’s personal credit, including the requisition of a credit
report from any credit agency. Parks guarantees all products it sells. If you are not satisfied, notify us within 24 hours and
return such products in original wrapping or container. Unfortunately, Parks cannot be responsible for weather or
transportation delays of orders. Verbal agreements are invalid unless specifically authorized by the President or Board of
Directors of Parks. The company hereby agrees to indemnify, defend and hold Parks and its directors, officers and employees,
harmless from and against any and all costs, losses, fees or expenses (including reasonable attorney’s fees and court costs)
resulting from or arising out of any claims from any and all third party customers of the company or any acts or omissions of the
company. Parks hereby disclaims, and the company hereby waives, any and all warranties, express or implied, including but not
limited to, the warranty of merchantability and any warranty of fitness for a particular purpose. I/we further authorize Parks or
any of our affiliates, to notify me as a customer in any method, including but not limited to, facsimile, email or mail, information
regarding our inventories, prices or other pertinent information regarding our business
.
Executed this ___________________ Day of _________________________________, 20_______
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