Customer Application Form

Customer Application Form
Salesperson*
Select Your Sales Rep
Salesperson

First NameLast Name
Account Name*
Responsible Party*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail*
Federal Tax ID
Sales Tax Exempt?

YesNo
Sales Tax Exempt #
Please include copy of exempt certificate.
Exempt Certificate

Upload a File

Cancelof
Type of Entity
Other*
Purchasing Docs Required for Invoicing
Other*
Credit Terms*

Net 30Net 15PrePayDOR50/50
Total Credit Line Desired

Authorized Purchasing Personnel
Name 1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Authorized for Purchase?

YesNo
E-mail
Name 2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Authorized for Purchase?

YesNo
E-mail
Name 3

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Authorized for Purchase?

YesNo
E-mail
Name 4

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Authorized for Purchase?

YesNo
E-mail

Trade Credit References
Not required for PrePay terms.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail

Bank References
Bank Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Fax

Area CodePhone Number
Checking/Savings Account #
Savings

YesNo
Loan

YesNo
Bank Officer/Contact Name

First NameLast Name
Certificate of Deposit

YesNo
Are Financial Statements Available

YesNo

CONDITIONS FOR THE EXTENSION OF CREDIT

For the purposes of obtaining an extension of credit, I/we (“Applicant”) state that all of the information contained in this application is true and correct. The parties hereby agree that services are rendered subject to the following terms and conditions:
- All invoices are due and payable on terms granted. An NSF charge of $25.00 shall be assessed for returned checks.
- Amounts past due are subject to a finance charge of 1.5% (or highest rate allowed by law) each month (18% per annum) until the balance is paid in full.
- If any collection action is undertaken, Team Pride Athletic Apparel, LLC, All Star Lettering, Macs Worldwide, and GS Sports Ventures shall be entitled to recover collection costs, a reasonable attorney’s fee, all court costs, and all legal interest accrued on past due principal amounts.
- I/we hereby authorize banks and creditors listed above to release information needed to establish our credit.
Name*

First NameLast Name
Title
Name

First NameLast Name
Title
I agree with all of the above.*

Yes
Should be Empty: