Eco-Maxx Fluid Resources, LLC Confidential Business Credit Application

    Salesperson

    Acct. #

    Date

    Company Information

    Name of Business

    Tax ID Number

    Address

    City

    State

    Zip

    Phone

    Type of Business

    In Business Since

    Legal Form Under Which Business Operates

    CorporationPartnershipProprietorship

    Principal Owner Information

    Last Name

    First Name

    Middle Initial

    Title

    SS#

    Address

    City

    State

    Zip

    Phone

    Bank Reference

    Institution Name

    Checking Account No

    Bank Address and Phone

    Trade Reference 1

    Company Name

    Contact Name

    Address

    Phone

    Fax

    Trade Reference 2

    Company Name

    Contact Name

    Address

    Phone

    Fax

    Trade Reference 3

    Company Name

    Contact Name

    Address

    Phone

    Fax

    This is to certify that our firm is financially able to meet any commitments we have made and to pay our invoices according to terms (NET 30). We agree to pay a minimum service charge of 1.5% per month on all past due invoices. Eco-Maxx Fluid Resources, LLC retains the right to withhold and/or deduct any contra balance owed to purchaser if account is past due. Any account classified as past due at that time will be placed on C.O.D until the account is returned to a current status and/or the credit line is re-evaluated. Purchaser agrees to pay all costs of collection, including a reasonable attorney's fee should legal action be necessary. I hereby certify that the information contained herein is complete and accurate and authorize Eco-Maxx Fluid Resources, LLC to verify this information.

    Signature

    Title (Officer of Company)

    Date

    Guaranty

    In consideration of granting credit to the Applicant, the undersigned hereby guarantees to Eco-Maxx Fluid Resources, LLC and to its heirs, successors and assigns, the payment of any and all balances due by the Applicant on this account or any account of any successor to this Applicant including service/finance charges, collection costs and reasonable attorney's fees.

    Date

    Name

    Signature