Credit Application

Company Name____________________________________________________________

Mailing address_________________________________________________________________

City________________________State______Zip________Phone________________________

Shipping address________________________________________________________________

City________________________State______Zip________Phone________________________

Type of Business__________________________ Annual volume_________________________

Social Security or Federal ID #_____________________________________________________

Years in business____________Personal__________Partnership__________Corp____________

Bank affliliation______________________________Phone______________________________

Address____________________________________Contact_____________________________

Phone:  Accounting Department: _____________________________________

E-mail:  Accounting Department: _____________________________________

Fax:  Accounting Department: _______________________________________



Credit References: List two of your primary suppliers. Please supply complete addresses. Type or print in spaces provided below.

1. Company Name _____________________________

Street _____________________________

City, State, Zip _____________________________

Area Code/Phone ___________________ Fax____________________

E-mail ______________________________

2. Company Name _____________________________

Street _____________________________

City, State, Zip _____________________________

Area Code/Phone ___________________ Fax ____________________

E-mail ______________________________

 

By signing below, applicant agrees that:

  1. Terms of Sale: 1%-10, Net 30 days from date of invoice.

  2. Balances unpaid beyond 30 days from invoice date are subject to a delinquency charge of
    3. 1.5% per month (18% annual percentage rate).

  1. The undersigned is responsible for reasonable attorney’s fees and court costs incurred by Atlantic
    2. Fasteners Co., Inc. in collecting any amounts due it or in enforcing its rights.

  1. Written notice of any defective merchandise must be received within thirty (30) days of your
    2. receipt of such merchandise. Atlantic shall not be responsible for any consequential or other damages. There are no express or implied warranties including any warranty of merchantability, which extend beyond the description in any invoice or sale receipt tendered at time of purchase.

    5.   Sales tax is to be handled as follows (check one and provide certificate, if required):

    ___ Purchases from Atlantic Fasteners are subject to sales tax

    ___ Purchases from Atlantic Fasteners are not subject to sales tax. Please submit your sales tax exemption certificate with your credit application

    ___ Purchases from Atlantic Fasteners are subject to sales tax. We will pay the tax

 

Date________________________ Company_____________________

A/P Contact (Please Print Name)_____________________________________

By _______________________________________

(Please Print Name)_______________________________________

Title________________________________

 

 

Mail to: 49 Heywood Ave., PO Box 1168, W. Springfield, MA 01090

Fax to: 1-413-785-5770

Or sign, scan into computer, and e-mail to: info@atlanticfasteners.com