Credit Application

* Required Fields

APPLICANT INFORMATION
Legal Business Name *
Street Address *
Street Address Line 2
City *
State *
Zip *
Mailing Address *
Mailing Address Line 2
City *
State *
Zip *
Phone *
Fax *
Email *
Ship to Address *
Ship to Address Line 2
City *
State *
Zip *
Person to contact about Account *
Phone *
Amount of Credit Requested *
$
Type of Business *
How Long in Business? *
BUSINESS INFORMATION
Please select a business type *
BANKING INFORMATION
Attaching my own Banking sheet Fill out Banking Information online
TRADE REFERENCES (Please fill out 3 references)
Attaching my own Reference sheet Fill out References online
The preceding information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize CB Manufacturing to investigate all references and customary credit information sources including consumer credit reporting repositories regarding my/our credit and financial responsibility for the purpose of obtaining credit and for periodic review for the purpose of maintaining the credit relationship.

CREDIT POLICY: Statements are rendered as of the CB Manufacturing C.O.D. restrictions may be placed on any past due account.

CREDIT TERMS: All invoices are due net 30 days. A service charge of one and one half percent (1 ½% per month), or (18% per annum) or the highest legal rate, which ever is less may be assessed on delinquent invoices.

VENUE: All amounts due for purchases from CB Manufacturing are payable at 4455 Infirmary Road, Miamisburg, OH 45342. It is further agreed that this agreement is entered into in the state of __OHIO_ and is governed by the laws of the state of __OHIO__.

CHANGE OF OWNERSHIP: I/We understand that we must notify CB Manufacturing in writing and by certified mail of any change in ownership, the name of the business or structure of the business under which credit is established.

In the event of default, and if this account is turned over to an agency and/or an attorney for collection, the undersigned agrees to pay all reasonable attorney fees, and/or costs of collection whether or not suit is filed.

I/We certify that this request is for the extension of credit for business purposes only and not for the extension of credit for personal, family or household purposes.

APPLICANT'S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS:
Firm Name *
By *
Title *
By
Title
The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with law concerning this credit is the Federal Trade Commission, Division of Credit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.

4455 Infirmary Road, Miamisburg, OH 45342
Phone: 937-866-5986 – Fax: 937-866-6844
Toll Free: 800-543-6860
 
ACCOUNTS PAYABLE INFORMATION
Company Name *
Accounts Payable Contact *
AP Phone# *
Ext
AP Fax# *
AP Email Address *
What is your Invoicing Preference?* Please pick at least one. If you would like your invoices sent multiple ways, please check all that apply. You may include up to four fax numbers or email addresses.
Email(s)
Fax Number(s)
Hard Copy Sent to
Company Name
Street Address
City
State
Zip
 
I have read the above terms and by clicking here I
agree to them. *
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