New Account Credit Application

Company Information:

* Company Name:

* Address:

* City: * State: * Zip:

* Telephone #: Fax:

* Email:

* The Owner or Name: Title:

Officers are:

Name: Title:

Name: Title:

If Sole Owner, Please Complete This Section

Full Name:

Home Address:

City: State: Zip:

Home Telephone#: Spouses Name:

Your Social Security #: Federal Tax ID #:

Corporation ?: yes , no

Business Established: Month , Year

We Anticipate we will require a Credit Line of $ to handle our purchasing levels.

Primary Banking: Bank Name: Business Acct.#:

is done with: Address: Personal Acct.#:

* City: * State: * Zip:

Bank Telephone#:

Authorization to obtain credit information for officers, partners, or owner:

Name: Title:

Signature (type name):

By signing: I (We) consent that you may release normal credit information. Relative to my account, as named above, to Brad’s Safe and Lock Service, Inc.

Trade References: (30 Day Accounts)

1 Company Name:

Address:

City: State: Zip:

Phone#: Contact Person: Account #:

2 Company Name:

Address:

City: State: Zip:

Phone#: Contact Person: Account #:

3 Company Name:

Address:

City: State: Zip:

Phone#: Contact Person: Account #:

All Invoices are due within 30 days of ordering or receiving date. All invoices past 30 days will be charged a 1.5% late charge per month. You also agree to pay attorney fees, collection agency fees and other costs associated with their collection efforts. The laws of the State of Maryland shall govern our relationship.

* Signature(type name): * Title: * Date:

*required fields