Credit Application

Your Sales Person:

Company Legal Name:

DBA Name if any (name on door)

Name *

First

Last

Email *

Invoices & Statements Email *

Phone 1 *

Owner / Manager Cell Number

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Delivery address (if different from Billing above)

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL

Sales Rep

Please list who is your sales representative so that we can give proper credit to them for maintaining your relationship.

Credit Information

Tax ID

Bank Name / Address / Account / Contact Person & Phone Number

Please list 3 trade references including Company Name / Contact Name / Phone Number

Credit Card Number

Expiration Date

CSV Code

Any misrepresentation in this application will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grant credit, the undersigned warrants that the information submitted isTrue and correct. You are authorized to investigate the trade references and bank references and principals listed.In Consideration of the extension of credit by ALL NATURAL PRODUCTS, INC. to the business identified below, said business promises to pay for all purchases according to the terms agreed upon (7days and agrees to pay a service charge of 1.5% per month (18% annual percent rate) on all past due balances. In the event of failure of said business to pay for all purchases according to the terms agreed upon necessitates retention by ALL NATURAL PRODUCTS, INC. of a third party to collect any outstanding monies owed by said business, the undersigned agrees to pay all reasonable collection costs, including attorney’s contingent or hourly fees, whichever may be greater, whether or not litigation has commenced, and all costs of litigation that may be incurred. The undersigned represents that he/she has the authority to execute this Credit agreement on behalf of the business identified. Should it become necessary to file suit to enforce payment, applicant agrees that such suit maybe brought in Las Vegas, NV or New York at the seller’s option. NAME AND DATE: *

Secret Word That Would Identify you to this account:

Provide any word that would identify you as you... Your Favorite Car, Movie, Friend, City or State, etc.