Parker Ranch Wholesale »

Wholesale Credit Application

CREDIT APPLICATION
The undersigned is applying for credit with Parker Ranch, Inc. (“the Company”) and agrees to abide by the terms and conditions of the Company’s standard contract.
Part 1: Applicant Information
Applicant Full Name:
Your Title:
Mailing Address:
City:
State:
Zip:
Phone Number:
FAX Number:
Email:
   
Part 2: Business Information
Business Name:
Type of Business:
Number of Employees:
Date Business Established:
Tax ID Number:
Types of goods or services you will purchase and business purpose:
Amount of Credit Requested:
$
Check which is applicable to you:
Corporation
General Partnership
Limited Partnership
LLC
Sole Proprietorship
Other
State where your business was organized:
Have you or any of your affiliates ever had credit with us or purchased from us before?
 Yes
No
If yes, under what name:
Name or title of person authorized to act on your behalf:
   
Part 3: Trade References
Reference #1 Name
and Address:
Reference #1 Phone:
Reference #2 Name
and Address:
Reference #2 Phone:
Reference #3 Name
and Address:
Reference #3 Phone:
   
Part 4: Bank References
Name of Bank #1:
Contact Name:
Bank Phone:
Bank Address:
 
Name of Bank #2:
Contact Name:
Bank Phone:
Bank Address:
   
Part 5: Financial Information
Assets:
 $
Liabilities:
 $
Approximate Annual Net Income:
$
Have you or your officers ever filed a petition in bankruptcy?
 Yes
No
Are you subject to any litigation?
 Yes
No
If so, describe here:
Are you current in meeting your other financial obligations:
Yes
No
 
Part 6: Policy Agreement Statement

We declare that the above information is true, correct and complete and is given to induce the Company to extend credit. We authorize the Company to make such credit investigation as the Company sees fit, including contacting the above trade references and banks and obtaining credit reports. We authorize all trade references, banks and credit reporting agencies to disclose to the Company any and all information concerning the financial and credit history of applicant.

Terms: Net 30 Days. A late charge of 1% per month will be added to all past due accounts. If collection action is necessary, customer agrees to pay for all costs of collection (including without limitation legal fees and court costs).
I Agree