Credit Application for TERMS

dba Bergeron by Design

15 S. Second Street, Dolgeville NY 13329
Phone: 800-994-2416 | Fax: 315-429-8862 /

Credit Application for TERMS

Business Contact Information
Name & Title:
Company name:
Phone: / Fax: / E-mail:
Registered company address:
City: / State: / ZIP Code:
Date business commenced: / How long at current address?
Sole proprietorship: / Partnership: / Corporation: / Other:
Percentage of Business / Internet: % / Brick and Mortar: % / Marketplace (EBay, Amazon):
%
Business and Credit Information
PLEASE FILL OUT ONLY IF APPLYING FOR NET 30 terms
Primary business address:
City: / State: / ZIP Code:
Telephone: / Fax: / E-mail:
Bank name:
Bank address: / Phone:
City: / State: / ZIP Code:
Name of Financial Institution: / Type of account: Savings, Checking, Other / Account number:
Business/trade references
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account:
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account:
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account:
Company name:
Address:
City: / State: / ZIP Code:
Phone: / Fax: / E-mail:
Type of account:
PAYMENT TERMS Agreement
Application for Terms:
To obtain credit terms, Retailer must submit a completed credit this application before the initial order, and update this information at Keekaroo’s request. Terms are Net 30. Keekaroo will approve credit requests and set credit limits at its sole discretion. After the Retailer’s credit is approved, Retailers are required to pay all invoices Net 30 days from date of invoice. When paying on credit terms, payment must be made by check or wire transfer, and be made within the agreed upon credit terms.
Past Due Accounts:
Unless otherwise agreed in writing by Keekaroo, accounts not paid when due will be suspended. Past due accounts forfeit any pending or future discounts, and Keekaroo reserves the right to discontinue business with any account that is repeatedly late in making payments. Retailers are responsible for and shall pay any and all reasonable expenses of collection, including collection agency and/or attorney fees.
Order Instructions:
After obtaining terms, users will log into www.keekaroo.com to place orders, selecting the “Pre-Approved Terms.” PO #’s are required for the completion of order, inputted in the Comment Section. By signing in with your personal account number and password will serve as a signed PO.
Signature
Signature: / Signature:
Print: / Print:
Title: / Title:
Date: / Date: