SAMPLE OPEN ACCOUNT AGREEMENT
Please complete the following form in its entirety. Incomplete applications may be returned unprocessed.
Please type or print legibly
Legal Business Name: ______
Business Name utilized (if different from above): ______
Billing Address: ______
Shipping Address: ______
City, State, Zip: ______
Telephone Number: ______
Form of Entity:
___Corporation ___Limited Liability Company ___Partnership ___ Limited Partnership ___ Sole Proprietorship
___ DBA ___DBA of whom? ______Other (describe) ______
Principle Business Activity: ______Date Started: ______
How long in business under its present ownership? ______(Note: If the business is sold, acquired, is a party to a merger, or the form of the entity is changed, you must notify us in writing, by certified mail, within (____) days of such change.
Federal I.D. #: - Tax Exempt: Yes No Number: If Yes, attached certificate must be completed.
(or, If yes, attach certificate.)
Is this business a subsidiary/affiliate of any other entity? Yes _____ No _____
If yes identify the entity (ies) ______
Are purchase orders required? Yes No If so, are only specific individuals authorized to issue purchase orders? Yes ____ No ____. (Indicate yes only if your company is set up to manage “only authorized individual” situations.) Names of persons authorized to issue purchase orders:
______
Please provide a sample signature for each identified authorized individual. You must notify us in writing to cancel any such authorization.
Owners, Members, Partners and/or Officers:
Name Title Home Address Home Phone Social Security #
______
______
Please provide a copy of your most recent monthly/quarterly and annual financial statements and state whether your annual financial statements are audited by independent CPA’s _____, reviewed by independent CPA’s but un-audited _____, or prepared/reviewed only by customer ____.
Bank References:
Bank: Address: ______Phone:
Checking Account #:______Savings Account # ______
Officer to Contact: ______
Trade References:
Company Name Address Contact Person Phone Number
______
______
Has this business or any predecessor in interest (general partners, if a general or limited partnership; owner, if a sole proprietorship) ever filed a petition in bankruptcy, been the subject of an involuntary petition in bankruptcy, or been the subject of a request for receivership? Yes__ No __ If so, when? ______State in which filed: ______
Please note that we report account payment history to NACM Intermountain and it will become part of your business’ credit history.
Signature required on reverse side
TERMS & CONDITIONS OF OPEN ACCOUNT
(Please Read Carefully)
Sample Terms
PAYMENT TERMS ON EQUIPMENT PURCHASES AND RENTAL AGREEMENTS ARE NET 10 DAYS. PAYMENT TERMS ON SERVICE AND PARTS SALES ARE NET 30 DAYS. (Your Company) reserves its right in its sole discretion to cancel/reduce credit and refuse to make future credit sales. Customer agrees to review immediately upon receipt, each of (your company)’s statements and advise of (your company) of any discrepancy/dispute within 20 days of receipt of each such statement, together with a written statement for any discrepancy/dispute for any amount in excess of $_____ on any single statement. Failure to do so constitutes a waiver of any claim for such discrepancy/dispute.
In the event any balance due is not paid timely, payments may be applied first to costs of collection, attorneys fees and interest and then to principle even though the invoices being paid are designated on the payment remittance. Interest at the rate of % per month will be charged on all amounts not paid within 30 days after due date, both before and after judgment, and continuing each month until paid in full. In the event of default, the undersigned agrees to pay all costs of collection, including fees of any collection agency in the amount of not less than _____% of all amounts dueand attorneys fees whether hourly or contingent, but not to be less than __ % of the amount due if contingent, together with costs of court and further agrees that any legal action brought hereunder may be brought in _(County) , Utah. No terms or conditions hereof may be changed except by written consent of (Your company). All sums due for rentals, goods and/or services purchased, by, for, or on behalf of the undersigned are payable to (Your company at your address, city, state, zip code, county, state).
This Agreement shall be binding upon the successors and assigns of (Debtor) (“Debtor”) and regardless of any subsequent incorporation, reorganization, merger, consolidation of Debtor, change of partners, change of name or any other change in the composition of Debtor.
The undersigned warrants that he/she has the authority to execute this Open Account Agreement for Debtor and to bind said company to the terms contained herein and further certifythat the information provided herein is true and correct. Customer further certifies that this request is for the extension of credit for business purposes.
Debtor hereby accepts and agrees to the terms and conditions stated above including the payment terms.
I/we hereby authorize you or your agent/representative to secure a credit report regarding Debtor from time to time in connection with the extension or continuation of credit represented by this Agreement or the collection of debts resulting therefrom. Debtor further agrees to the release of credit information, including the reporting of credit history to credit reporting agencies, consistent with the Fair Credit Reporting Act 15 U.S.C. §1681, et seq., as amended. This authorization shall be continuing without expiration. A photocopy or facsimile copy shall be given the same effect as the original.
SIGNATURE REQUIRED TO PROCESS
DATED this day of , 20 .
(Debtor) Debtor SSN/EIN ______
By Debtor address ______
Print Name ______
Title Contact Person ______
Phone __ Fax __ E-mail ______
PERSONAL GUARANTEE
Jointly and Severally
In consideration of (creditor) extending credit to (debtor) , I/We the undersigned, hereby jointly and severally guarantee the prompt performance of the duties and obligations set forth in the above Open Account Agreement including payment to (creditor) , its successors, and assigns by (debtor) and its related entities (hereinafter collectively referred to as “Debtor”), together with interest at the rate of % per month, on all amounts not paid by the ( ) of the month following the month of purchase, both before and after judgment, all costs of collection including collection agency fees in the amount of not less than _____% of all amounts due and attorney fees whether hourly or contingent, but not to be less than ___% of all amounts due if contingent. Payments may be applied first to costs of collection, attorneys’ fees and interest and then to principle even though the invoices being paid are designated on the payment remittance. The undersigned further agree(s) that any legal action hereunder may be brought in ______County, Utah. Liability of the undersigned shall not be affected or prejudiced by the additional acceptance of a note or other evidence of indebtedness, the extension of time for payment, payment arrangements, updating of the Open Account Agreement or other indulgence granted to Debtor, or by agreement affecting said indebtedness, and the undersigned hereby waives notice of any or all of the aforesaid. The filing of suit or exhaustion of collection or legal remedies against Debtor shall not be a condition precedent to the enforcement of this guarantee and the undersigned hereby expressly waives presentment for payment, demand, protest, notice of protest or diligence. This Guarantee is an absolute, continuing, unconditional, and unlimited Guarantee. The term of this Guarantee shall commence on the date first above indicated. No termination of the Guarantee shall be effected by the death of the Guarantor or any of the Guarantors. This Guarantee shall be effective regardless of any subsequent incorporation, reorganization, merger or consolidation of the Debtor, change of partners, change of name or any other change in the composition, nature, personnel or location of the Debtor whatsoever.
I/We hereby authorize you or your agent/representatives to secure a consumer credit report from time to time regarding the undersigned inconnection with the extension or continuation of credit contemplated herein or the collection of debts resulting therefrom. The undersigned further agree(s) to the release of credit information, including the reporting of credit history to credit reporting agencies consistent with the Fair Credit Reporting Act, 15 U.S.C. §1681, et seq., as amended. This authorization shall be continuing without expiration and a photocopy or facsimile copy shall be given the same effect as the original.
Signature: Date:
Print Name ______
Social Security #:
Signature: Date:
Print Name ______
Social Security #:
WITHOUT SIGNING AND DATING, THIS APPLICATION CANNOT BE PROCESSED!
NOTICE
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Consumer Financial Protection Bureau, P.O. Box 4503, Iowa City, Iowa 52244.
AUTHORIZATION TO OBTAIN CONSUMER CREDIT REPORT/HISTORY
The undersigned hereby consent(s) to [name of creditor]’s use of a non-business consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s), member(s), partner(s), proprietor(s) and/or guarantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize(s) [name of creditor] to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as [an] individual(s) hereby knowingly consent to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. @ 1681 et seq.
Name:
Address:
City: State: Zip:
Signature: Date:
Social Security #: / /
Name:
Address:
City: State: Zip:
Signature: Date:
Social Security #: / /
NOTICE
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicants income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Consumer Financial Protection Bureau, P.O. Box 4503, Iowa City, Iowa 52244.
SAMPLE CREDIT DENIAL LETTER
DATE
ABC Company
123 Street
Anywhere, USA
Gentlemen:
We appreciate your interest in doing business with our company.
Based upon the information we have received, it is not possible for us [to establish an open account for you] [increase your credit limit] at this time. If you have additional information which may assist us to reconsider this decision, please provide it within five (5) days from the date of this letter.
If you would like a statement of specific reasons why your application was denied, please contact [list name and address of individual or position within the credit department] shown below within 60 days of the date of this letter. We will provide you with a statement of reasons within 30 days after receiving your request.
Until we receive additional information, we will gladly service your needs on a C.O.D./cash basis.
Sincerely,
John Doe
Credit Manager
NOTICE
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicants income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is theConsumer Financial Protection Bureau, P.O. Box 4503, Iowa City, Iowa 52244.
What You Should Say To Your Potential Customer When You Are
REFUSING CREDIT
Under the Fair Credit Reporting Act as it is presently written, YOU ARE NOT REQUIRED TO DIVULGE YOUR SOURCES OF INFORMATION IN BUSINESS TO BUSINESS CREDIT INVESTIGATIONS.
If you are going to refuse credit:
The following phrase should be used:
The information we have does not allow us to open a credit account for your company at this time.
If the applicant asks if you have checked with a Credit Association, and if you DID check with NACM Intermountain Credit Reporting Dept.
Your reply should be:
Yes, we did, but we still do not have sufficient information to warrant opening an account for your company at this time.
If the applicant INSISTS on knowing what its record is with NACM Intermountain.
Your reply should be:
We cannot divulge this information as it was given to us confidentially, but we will be glad to go back to our source for verification of the information.
If the application was supported by a personal guarantor or you also required information from individuals:
Your reply must include the name, address and phone number of the credit reporting agency that provided the consumer report(s).
All credit information you receive from NACM Intermountain, written or verbal, is strictly confidential and for the exclusive use of your Credit Department. We will be happy to verify the credit information you receive.