Volland Electric Equipment Corporation
75 Innsbruck Drive   Buffalo, NY 14227
(716) 656-9900   (800) 782-6877     Fax (716) 656-8599

APPLICATION FOR CREDIT

NAME OF FIRM OR INDIVIDUAL
FEDERAL ID NUMBER PURCHASE ORDER REQUIRED ?
Yes No		 CREDIT CARD PAYMENT
Yes No
DBA
TYPE OF BUSINESS
 YR ESTABLISHED YRS AT PRESENT LOC
ADDRESS
BUYER'S NAME PURCHASE ORDER REQUIRED?
Yes No
CITY STATE ZIP
SHIP TO:
PHONE FAX
ADDRESS
EMAIL ADDRESS ACCTS PAYABLE CONTACT
CITY STATE ZIP
TAX EXEMPT?
Yes No		 TAX EXEMPT #
PHONE FAX
 
THE FOLLOWING MUST BE COMPLETED BY OWNERS, PARTNERS, OR OFFICERS
 
OWNERSHIP: CORPORATION Incorporated in
last 12 months		 PARTNERSHIP PROPRIETOR / Social Security No:
NAME(S) OF PRINCIPAL(S) TITLE HOME ADDRESS CITY STATE ZIP
1.
2.
3.
 
AUTHORIZATION: To induce Volland Electric Equip. Corp. to extend a line of credit for purchases under credit sales terms as stated on invoices, we authorize you to contact the banks and trade references listed below. We also understand that this information will be held in strict confidence and will be used solely for the consideration of extension of credit.
Signature Title Date
 
BANK REFERENCE:
BANK NAME ADDRESS CITY STATE ZIP
PHONE FAX CONTACT ACCOUNT NO.
TRADE REFERENCES: (Suppliers Only - 4 references are required to process your credit application)
BUSINESS NAME CITY STATE ACCOUNT NO. PHONE NO. FAX NO.
1.
2.
3.
4.
CREDIT TERMS AND CONDITIONS:
This credit application is valid for a period not to exceed 2 years from approval date. Credit can be withdrawn at any time for violation of the stated credit terms. Upon failure of applicant to pay any indebtedness to Volland Electric when due, the entire balance may be declared in default and immediately due and payable upon demand. Applicant agrees to pay any and all attorney fees, court costs, collection agency fees, etc. incurred in the collection of said account.
 
PERSONAL UNCONDITIONAL GUARANTEE
In consideration for the extension of credit by Volland Electric Equipment Corp., the undersigned guarantor individually, jointly, severally and unconditionally guarantees the prompt payment of all sums for which applicant becomes indebted to Volland Electric Equipment Corp.
 
Agreed By:
Signature of Applicant/Guarantor Date
Applicant/Guarantor's Printed Name Title
   

 

* Please note : This application is first part of application process. You will be contacted upon completion and submission of this application for any further information needed.