Credit Application

General Information
Firm:
Doing Business As:
Street Address:
PO Box:
City:
County:
State:
Zip:
Telephone:
Fax:
Email:
Type of Business:
Date Established:
State Registered:
Building:	Select...OwnedRented
Type of Jobs:	Commercial Residential Apartments
Number Years in Business:
Estimated Monthly Purchases:	$
Approximate Net Worth:	$
Business is:	Select...Sole ProprietorshipPartnershipCorporation
Federal Tax ID #	This field is encrypted.

Names of all Owners, Partners or Officers
Name	Social Security #	Residence Address	% of Ownership	Title

Present Sources of Supply
Name of Supplier	City	Phone	Years Purchased	Average Monthly Purchases
Permission to research business credit history:		YesNo
Permission to research personal credit history:		YesNo

Purchase Information
Persons Authorized to Make Purchases:
Accounts Payable Contact Person:
Phone #:
E-mail Address:
Billing Preference:		MailEmail
Purchase Order Required?		YesNo
Job Name Required?		YesNo
Name of Bank	Address	Account #	Highbank Credit Used	Amount Owed
			YesNo
			YesNo
			YesNo
			YesNo
			YesNo

Spouse Information
Spouse's Name:
Social Security #	This field is encrypted.
Place of Employment:

Note: Superior Equipment Sales, Inc. is a wholesale distributor and can only sell to licensed heating and air conditioning contractors.
We ask that you provide your current contractor's license #
Driver's License ID Number
Issuing State

TERMS: We, the undersigned, agree to pay all sums due according to the terms stated in your invoices, and we agree to pay a 2% per month (24% per annum) service charge on all amounts past due. We agree to pay all costs of collection, including a minimum of 33.33% attorney's fees. We agree that returned materials will be subject to a minimum 15% restocking charge. We agree that 2.5% handling charge will be added to credit card transactions.

The undersigned certifies the information supplied on this application to be correct, that it is submitted for the purpose of obtaining credit and agrees to all of the terms and conditions of sale of Superior Equipment Sales, Inc. We also authorize you to inquire of principal trade creditors, banks, other credit references to check credit and allow you to answer questions from others about your credit experience with us. The undersigned hereby waives all venue objections and agrees to notify Superior Equipment Sales, Inc, in writing, of any change in the form of ownership of applicant's business within five days of such change. The Applicant consents to jurisdiction, in relation to any matters arising from or related to this application or the obligations hereunder, in either state or federal courts having jurisdiction over Chesapeake, Virginia.