CREDIT APPLICATION
Company Name
Billing Address
Shipping Address
City, State & Zip
Telephone Number
Telephone Number
Fax
Fax
A/P Phone
A/P Contact
P.O. Required
Yes
FEIN
Tax Exempt
if yes, Please attach a valid California resale certificate
Corporation
Partnership
Proprietorship
State of Incorporation
List Two (2) Officers/Owners
1. Name
2. Name
Title
Title
Bank References:
Bank Name
Bank Officer
Phone
Account #
Bank / Credit References:
1. Name
Address
2. Name
Address
3. Name
Address
Phone #
Fax #
Phone #
Fax #
Phone #
Fax #
Acknowledgement:
Estrella's terms are Net 15 days from the date of the invoice. We verify the information provided in this credit application is truthful and accurate to the best of our knowledge. We agree that all purchases made for Estrella's or any employee of this company will be paid in accordance with the aforementioned terms. We, the purchaser, agree to pay 1.5% interest per month (18% annually), but not to exceed the maximum amount allowed by law for any past due balances. We also agree to pay any reasonable and valid attorney fees and/or other costs incurred by Estrella's for collections of any unpaid past due of disputed balance.
Signature
Print Name
Title
Date
(Officer or Owner)
No
Yes
No
City, State & Zip
Instructions: Fill out form then select print button located at bottom of form, sign, date and fax to (909) 483-3011
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Statement of Credit Terms
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