credit app

AC Controls Company, Inc.APPLICATION FOR CREDIT
P.O. Box 691000 Charlotte , NC 28227 Phone 704-545-4500, Fax 704-545-8980

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General
Firm Name:
Bill To Address:
Ship To Address:
Date Business Started:		Accounts Payable Contact:
Phone Number:		Fax Number:

Owners/Officers:
Name:		Title:
Name:		Title:
Name:		Title:
Name:		Title:

Tax Information
Firm is a: Corporation \| Partnership \| Individual
		Tax Payer ID or SS #
Taxable:	Yes No If exempt, please attach exemption certificate.

Credit Details
Credit Amount Requested:	Duns #
	Insure Shipping	Yes No

Trade References
Name	Address	Phone Number

Banking
Bank:
Bank Officer's Name:		Phone No:

Applicant's signature attests financial responsibility, ability and willingness to pay our invoices in accordance with the following terms:

AC Controls Company, Inc. GENERAL TERMS AND CONDITIONS apply to all sales.

PAYMENT TERMS: Net amount of invoice in full within thirty (30) days of date of shipment. If, in our opinion, the financial condition of the purchaser at any time does not justify continuance of shipment on the terms of payment specified , we may require full payment in advance. No shipments will be made on open account unless satisfactory credit is established prior to shipping date.

INTEREST ON UNPAID BALANCE: Invoices not paid in full within thirty days of date of shipment will accrue interest at the rate of one and one-half percent (1 1/2%) per month on the unpaid principal balance.

ATTORNEY'S FEES: In the event that an invoice remains unpaid after thirty (30) days of shipment, purchaser agrees to pay to us all costs incurred in collecting the balance owing, including reasonable attorney's fees in the amount of fifteen percent (15%) of the outstanding balance on such invoice.