Dealer Application
   

CONFIDENTIAL QUESTIONNAIRE   Please print or Type

PERSONAL DATA
Name :
Address :
City : State : Zip :
Telephone Home : ( )
Business : ( )
Cellular : ( ) Fax : ( )
Web Address :
E-Mail Address :


EDUCATION
Name of School or University :
Location :
Highest Level of Education Completed :
Diploma Received :


WORK HISTORY
Company Name :
Company Address :
City : State : Zip :
Job Title :
Are you an owner or partner in this business?   Yes No
Type of Business :

 

CONTRACTOR CREDIT APPLICATION
AND AGREEMENT

As used in this application and agreement, the term "COMPANY" means that legal entity and all of its affiliates and other related entities. "CORBOND CORPORATION" means CORBOND CORPORATION and its subsidiaries affiliates, or other related entities.

Company Name :
Office Address :
 
Phone : ( ) Fax : ( )
Ownership : Corporation
    Limited Liability Company
    Partnership
    Limited Partnership
FEDERAL EIN NUMBER :
Years in Business :
Officers with Titles : 1.
    2.
Individual Owner of Company : 1.
    2.
Credit Line Amount Requested : $
Credit Line Amount Approved by Corbond Corporation :
Signed :


BANK REFERENCE

Name :
Address :
Telephone : ( )
Fax : ( )
Contact Person :
Title :
Account Number :
Signature to Release Bank Information :
Print Name of Person Signing Above :


TRADE REFERENCES

THREE are required
(Including Reference Name, Person in Charge, Telephone and Fax Numbers)

1. Company :
  Contact :
     
  Telephone : ( )
  Fax : ( )
2. Company :
  Contact :
     
  Telephone : ( )
  Fax : ( )
3. Company :
  Contact :
     
  Telephone : ( )
  Fax : ( )

CREDIT POLICY

A Trademark License Agreement, current credit application, credit agreement, and credit card authorization with personal guarantee are required to be on file at all times. A trade credit account will not be opened without them. Corbond Corporation reserves the right to extend, change or withdraw credit at its sole discretion without prior notice. Credit limits are determined solely by Corbond Corporation's credit department.

Corbond Corporation offers a prompt payment discount of $25.00 per drum on raw material purchases when the invoice is paid in full within 15 days from the date of the invoice, Net 30 days, no discount. Prompt payment discount amounts appear as a note on the bottom of the invoice. Accounts with a past due balance are not eligible for discounts. Prompt payments are those payments postmarked not later than three days after the due date as stated on each invoice. The three day grace period allows for due dates falling on holidays or weekends. Credit card payments are accepted as cash payment at the time of purchase only. Credit card payments that are made AFTER TIME OF PURCHASE are NOT allowed the cash discount.

Interest at the rate of 1.5% per month (18% APR) will accrue on past-due invoices. Accounts with any past due invoice balance will not be extended any further credit on goods unless prior arrangements are made with an authorized representative of Corbond Corporation.

Payments received on past due accounts will be applied to interest first and then to the oldest invoice. Monthly statements will reflect the application of funds in this manner. Purchaser agrees to pay attorney and/or collection fees if any balance is turned over for collection.

Receipt of merchandise constitutes ongoing acceptance of the current credit terms.

 

PERSONAL GUARANTEE

       The undersigned, , in consideration of your extending credit to the aforesaid Applicant, jointly and severally, absolutely and unconditionally guarantee to pay Corbond Corporation, all monies which shall become due from by reason of any credit you extend as herein requested, including interest and all costs of collection and reasonable attorneys fees, in recovery of the debt if it is past due whether it be incurred against the debtor, guarantor or both.

       I/We hereby authorize Corbond Corporation, its successors and assigns, by its designated attorney to waive the issuance of service of process and confess judgment against it for the entire unpaid balance of the Applicant's account, together with all costs applicable to such action.

       I/We hereby waive any obligation upon you to make demand on the debtor and notice of default to us and consent to any extensions and renewals of the debtor's obligations hereof without notice to us. We authorize Corbond Corporation to release, at its sole option, and from time to time, any and all collateral given it by the debtor without affecting this guarantee.

DATED this day of , 20 .

By :
(Print Name)
 
Signature-Owner
 
Social Security #
By :
(Print Name)
 
Signature-Owner
 
Social Security #
By :
(Print Name)
 
Signature-Owner
 
Social Security #
By :
(Print Name)
 
Signature-Owner
 
Social Security #

       On this day of , 20 , before me, a Notary Public in and for said State, personally appeared , known to me to be the person whose name is subscribed to the within instrument, and acknowledged to me he executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal as of the day and year first above written.

Notary Public for State of
Residing at
My Commission expires

(Notarial Seal)
                 FOR CORBOND CORPORATION USE ONLY-Please do not write in this space.
Approved Amount: $ Terms: Open Account: Yes No Open Account Limit: $

The following information will help us to determine your readiness and suitability for selling and installing. This information will be held in strict confidence and will not be revealed to any third parties.


   
Copyright © 2008 Corbond Corporation, All Rights Reserved