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