PAYMENT REMITTANCE ADDRESS:
P.O. BOX 734472 DALLAS, TX 75373-4472
Winston Water Cooler | CREDIT APPLICATION
SOLE PROPRIETORSHIP
CORPORATION
PARTNERSHIP
OTHER
COMPANY LEGAL NAME
Operating trade name (if different)
billing address
contact name
contact email
contact phone
AP contact name
AP contact email
AP contact phone
**BY PROVIDING AN AP EMAIL, YOU ARE AUTHORIZING ALL CORRESPONDENCE TO BE SENT VIA EMAIL**
Does your company operate with a tax exemption?
yes
No
Upload File
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
shipping address (if different)
owner(s) officer(s)
years in business
have any of the above officers ever been involved in a personal or corporate receivership or bankruptcy?
no
yes
BANKING INFORMATION
Please fill out each of the following required fields:
TRADE REFERENCES
OFFICER'S NAME & E-SIGNATURE AUTHORIZATION
I/ We hereby apply to Winston Water Cooler, Ltd. for a line of credit. We hereby acknowledge and accept Winston Water Cooler, Ltd. terms of sale as Net 10th of every month. I/ We warrant that the information provided is true and is given for the purpose of obtaining goods from Winston Water Cooler, Ltd. on a credit basis. I/ We hereby authorize Winston Water Cooler, Ltd. to use and verify the above information in any area deemed necessary. Interest on accounts which are more than 60 days past due will accrue at the rate of 18% per annum, based upon the amount of any past due balances.
PERSONAL GUARANTEE
The undersigned certifies the above information to be correct that is submitted for the purpose of obtaining credit, and agrees to all the terms and conditions of sale of the company to whom it is submitted. In consideration of credit being extended or other financial accommodations to the above firm by Winston Water Cooler, Ltd. the undersigned, personally, jointly, and severally unconditionally guarantee to Winston Water Cooler, Ltd., the prompt payment when due or become owing to Winston Water Cooler, Ltd. from the above named applicant credit. Th undersigned further guarantees the payment of all interest, attorney's fees, court costs and other costs of collection which may be incurred by Winston Water Cooler, Ltd. All applicants must notify Winston Water Cooler, Ltd. immediately of any change in business name, address, and/or principal by certified or registered mail. All charges for merchandise sold under this account are expressly payable in Dallas, Dallas County, Texas.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Want to get in touch?
Drop me a line!
Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Name
Email Address
Form Label
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.