C O N F I D E N T I A L
Credit Department Fax: 978-772-7792
Account
Select one: Corporation Trust Partnership Proprietorship
Company Name

Address

City

State
Zip


Date

Tel. No.

Fax. No.

Federal ID No./Social Security No

Nature of Business

Dunns No.

No. Yrs. in Business

Principals
Name

Home Address

City

State
Zip


Social Security No
Name

Home Address

City

State
Zip


Social Security No
Bank References
Savings Bank Name

Address

City

State
Zip


Account #
Tel No.
Checking Bank Name

Address

City

State
Zip


Account #
Tel No.
Supplier/Commercial References
  Name Address Phone Number Fax Number
1.
2.
3.
4.
I hereby certify that all statements accompanying and contained in this application are true and made for the purpose of obtaining credit and in consideration of Laddawn, Inc. selling to me or my agent(s), I agree to the following terms:
(1.) To pay the account in full per terms Net 30 days, and to pay interest at a rate of 1 1/2% per month (18% per annum) for all invoices past due.
(2.) If this account is placed for collection, I agree to pay all reasonable charges for collection, including attorney's fees. I further agree that a charge of 25% of the claim shall be considered reasonable, as an attorney's fee and 30% of the claim shall be considered reasonable as a collection fee.
(3.) The undersigned authorize any credit investigation needed for action on this credit application and hereby indemnify Laddawn, Inc. from any liability resulting from their credit survey.
Personal Guarantee
The undersigned individual(s) hereby personally guarantees without any qualification or condition, any debts of the above named Corporate Applicant incurred prior to the receipt by the above companies, of written notice of the revocation of the guaranty by the undersigned.
Full Name


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