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