Credit Account Form Credit Application form Date MM slash DD slash YYYY Sales Person / Referred By: HiddenOnline Account: Check this box if you are interested in setting up an Online Main Electric Account which can be used to make purchases via our Website or Mobile App. View Open Backorders, Purchase History, Recent Orders, and much more… Company Name: Phone #: Streeet Address: Fax #: City: State: Zip Code: Mailing Address: Primary Contact Name: Primary Contact Phone #: Primary Contact E-Mail: General InformationCorporation:[ ] Corporation State of Incorporation: Date of Incorporation: MM slash DD slash YYYY Partnership:[ ] Proprietorship:[ ] LLC:[ ] Other:[ ] Describe: Partnership Proprietorship LLC Other Describe: Federal ID Tax#: Date Bussiness Started: MM slash DD slash YYYY Name of Owners, Partners or Officers (Include Home Address)NameAddressCity, StateSocial Security # Add RemoveWe are engaged in the business of: Date Established: MM slash DD slash YYYY Type of Contractor License: License Number: Number of Employees: Number of Electricians: Is a purchase order required? Are purchases taxable? If no, give resale #: Anticipated monthly purchases from Main Electric Supply Company: $Name and Phone Number of Individual Responsible for Authorizing PaymentName: Phone #:E-Mail: DUNS #: Credit References (List Principal Suppliers) :Supplier: Phone #:Address: E-Mail: Supplier: Phone #:Address: E-Mail: Supplier: Phone #:Address: E-Mail: Financial InformationPrincipal Business Bank: PPE Branch: Address: Account Type: Account #: Officer: Phone #:Please attach your latest prepared financial statement. If one is not available at this time, please fill in the financial information below.Financial Information as of (Date): MM slash DD slash YYYY Terms and Conditions Items qualifying for discount earn such discount if paid by the 10th of the month following the billing date. All invoices are due in full (net) on the agreed upon due date based on terms on account. A service charge of the lesser of 18% annually or maximum amount allowed by state law will be charged to all past due accounts. The payment or accrual of service charges does not extend credit terms or defer payment of any past due bill and I/we are subject to collection or legal action if any sum is not paid on or before the due date thereof. I/we hereby authorize any of the trade references and bank references listed in this application to provide Main Electric Supply Company with any and all information requested. All transferable warranties made to Main Electric Supply Company and/or United Electric Supply by the manufacturers of materials shall be assigned to you (applicant). Main Electric Supply Company and/or United Electric Supply make no additional warranties either expressed or implied. Main Electric Supply Company and United Electric Supply’s liability shall be limited to replacement or refund of the purchase price. I/we hereby consent to the jurisdiction of the Orange County Superior Court. In the event legal action is commenced to enforce any of the terms of purchase or obligations created hereby or here in after, I/we agree to pay costs of collecting past due amounts including, but not limited to, reasonable attorney fees, collection fees, interest and court costs. No term or condition hereof may be changed except by written consent of Main and United’s management. I/we understand, acknowledge, accept, and agree to Main Electric Supply Company and United Electric Supply’s terms and conditions and certify that the information given herein is true and correct. The undersigned is authorized by the principal referred to above to execute this credit application and/or personal reports.Company Name: Date MM slash DD slash YYYY Signature(Required)Title: Guarantee In consideration for Main Electric Supply Company extending credit hereunder, the undersigned personally, jointly and severally, and unconditionally guarantees and promises to pay Main Electric Supply Company on demand, any and all indebtedness of the above named applicant to Main Electric Supply Company. In consideration for United Electric Supply extending credit hereunder, the undersigned personally, jointly and severally, and unconditionally uarantees and promises to pay United Electric Supply on demand, any and all indebtedness of the above named applicant to United Electric Supply. These are continuing guarantees, and the obligations created hereby are unaffected by any changes in the terms of the original indebtedness between Main Electric Supply Company or United Electric Supply. The undersigned expressly agrees to be bound by all the terms and conditions set forth in the above credit applica- tion which is incorporated by reference herein.Signature(Required)Date MM slash DD slash YYYY Name Social Security #: Δ
