Credit Application

Application for Credit and Business Information Form

* Denotes required field.

APPLICANT

Legal Business Name (List all Trade Names, DBA’s, Divisions or Subsidiaries)

State Mechanical License No:

Street Address

City

State

Zip

Mailing Address (Same as above)

Street Address

City

State

Zip

Shipping Address (Same as above)

Street Address

City

State

Zip

Phone

Cell Phone

Email Address

Estimated Annual Sales

A/P Contact person

Amount of Credit Requested

How Long in Business

Type of Business

BUSINESS INFORMATION

Please select one:

Sole Proprietorship

Partnership

Corporation/LLC

Federal Tax ID/EIN # (If applicable)

Are you Tax Exempt by Resale Permit?

Yes

If No,

State Sales Tax %

County Sales Tax %

County Name

Local Sales Tax %

City Name

Total Sales Tax %

BANKING INFORMATION (Please fil out 3 references)

Credit Reference

Name

Address

Phone

Cell Phone

Email Address

Name

Address

Phone

Cell Phone

Email Address

Name

Address

Phone

Cell Phone

Email Address

Authorization

CREDIT POLICY: Statements are rendered as of the 1st and 15th of each month, C.O.D. restrictions may be placed on any past due account. CREDIT TERMS: All invoices are Net 30 day terms. Any invoice not paid in 45 days will incur a 1.5% finance charge. Any invoice not paid within 61 days is subject to an additional service charge of 1.5% per month or 18% per annum or the highest legal rate, whichever is less may be assessed on delinquent invoices each month. VENUE: All amounts due for purchases from Air Products Supply, Co. are payable at 266 Industrial Blvd., Goldsby, Oklahoma 73093. It is further agreed that this agreement is entered into in the state of Oklahoma and is governed by the laws of the state of Oklahoma. CHANGE OF OWNERSHIP: I/We understand that we must notify Air Products Supply, Co. in writing and by certified mail of any change in ownership, the name of the business or structure of the business under which credit is established. In the event of default, and if this account is turned over to an agency and/or an attorney for collection, the undersigned agrees to pay all reasonable attorney fees, and/or costs of collection whether or not suit is filed. I/We certify that this request is for the extension of credit for business purposes only and not for the extension of credit for personal, family or household purposes.

APPLICANT'S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS

Firm Name

Title

CONSENT TO OBTAIN CONSUMER CREDIT REPORT

The undersigned individual who is either a principal of the credit applicant our a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

Sign Name

Date

Print Name