Credit Application
The following information is submitted as a basis for the extension of credit.
A. Business Name _________________________________________________________________
Street Address ____________________________________________________________________
Mailing Address ___________________________________________________________________
City ________________________________________ State _____________ Zip ______________
Telephone _________________________ Fax number ____________________________________
Tax Exemption # _________________________________ Number years in business ___________
B. Our business is a: Partnership __ "S" Corporation __ "T" Corporation __ Proprietorship __
C. Principal owners and / or officers and / or partners are:
Name _____________________________________ Date of Birth __________________________
Address _________________________________________________________________________
Home Telephone __________________________________ Soc. Security last four numbers ______
Name _____________________________________ Date of Birth ___________________________
Address __________________________________________________________________________
Home telephone __________________________________ Soc. Security last four numbers ________
D. Bank Reference ___________________________________ Acct# _________________________
Address ___________________________________________________________________________
E. Trade References - only those references with an open account.
Name ______________________________________ Telephone _____________________________
Fax _______________________________ Address ________________________________________
__________________________________________________________________________________
Name ______________________________________ Telephone _____________________________
Fax _______________________________ Adsress ________________________________________
__________________________________________________________________________________
Name ______________________________________ Telephone _____________________________
Fax _______________________________ Address ________________________________________
__________________________________________________________________________________
F. Line of Credit amount requested: ______________________________________________________
G. In consideration of Growers Supply Service, Inc., extending credit, we do agree jointly and severally to pay for all goods, wares and merchandise supplied to any of us and or the above named business. In the event it becomes necessary to place the account with an attorney for collection, we agree to pay all costs of collection including reasonable attorney's fees and hereby waive our privilege of being sued in the county of our residence and agree if suit is brought, the venue will be in Orange County, Florida at the option of Growers Supply Service, Inc. We agree to immediately notify Growers Supply Service, Inc., of any change in ownership of form of said business. This instrument shall remain in full force and effect until actual notice of revocation is received by Growers Supply Service, Inc. The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize the firm to whom this application is made to make any inquiries they deem necessary pertaining to my/our credit and fiinancial responsibility.
Signed and delivered this _________ day of ___________________, the year 20____.
__________________________________________________________________________________________
___________________________________________________________________________________________ (Title) (Title)
Contract of Individual and / or Personal Guaranty
In consideration of Growers Supply Service, Inc., or its authorized agents hereafter called the same granting credit to hereinafter called a principal, the undeerrsigned guarantors jointly, severally and individually guarantee pyment in full, of all present and future indebtedness and any kind and nature, of the principal to Growers Supply Service, Inc., including but not llimited to, interest at the highest legal rate, reasonable attorney's fees, and court costs. This guaranty agreement is absolute, unconditional and continuing. This obligation of the guarantors hereunder shall be binding notwithstanding any of the following: extention of time for payment, alteration of the principal, or failure to give other notices required by law, and this guaranty shall become enforceable upon failure of the pricncipal to make payment of any indebtedness due Growers Supply Service, Inc., immediaely upon demend therefore at or after maturity. The obligation of each guarantor individually shall continue until written notice of termination is received by Growers Supply Service, Inc., at: Post Office Box 817, Apopka, Florida, 32704-0817, and shall terminate only as such guarantor giving notice, and only as to such indebtedness incurred subsequent to the date that such termination notice was received.
Individual ____________________________________________________Date _______________________
Individual____________________________________________________ Date _______________________
NOTE: Growers Supply Service Inc., must receive the original completed and signed credit application and personal guaranty before extending a credit line. Even if you fax the information to expedite your request, it is necessary to return to us the original application -- completed and signed. Thank you.