CONFIDENTIAL CREDIT APPLICATION
An Employee Owned Company. Established 1935
Contractor's License No. 457555
www.rwsmithco.com
858.530.1800
Salesperson # ____________
SHIPPING INFORMATION:
Please Fax to 858-536-7743
FULL OWNERSHIP ENTITY INFORMATION REQUIRED
OWNER INFORMATION:
Trade Name or Style (DBA)
Sole Owner Partnership Corporation
_______________________________________________________________________
Name
Street Address
________________________________________________________________________
_______________________________________________________________________
Street Address
City, State County Zip
______________________________________ ___________________ _____________
_______________________________________________________________________
City, State County Zip
Phone Number Fax Number
_____________________________________________ ___ _______________________
(__ ___ )___________________ __________(__ ___) _____________________
Phone Number Fax Number E-Mail Address
Mailing Address, if other than above E-Mail Address
( ) ( ) ___________________________________
_______________________________________________________________________
Federal Tax ID Number State Of Incorporation No. of Years in Business
No. of Years under Present Ownership Type of Business
_________________
_______________________________ _________________________________
PRINCIPAL OWNERS OR OFFICERS INFORMATION:
1. Name 2. Name
________________________________________________________________________ __________________________________________________________________________
Title Social Security Number Title Social Security Number
________________________________ _____________________________ __________________________ _______________________________
Home Address Home Address
________________________________________________________________________ __________________________________________________________________________
City, State Zip City, State Zip
________________________________________________________________________ __________________________________________________________________________
Home Phone Number Home Phone Number
(_______)________________________________________________________________ (______)___________________________________________________________________
BANKING: Branch Office / City Phone Number
Bank Name Checking Account Number
_________________________________________________________________________ ( ) ____________
TRADE REFERENCES: preferably other major non-perishables suppliers. (General Contractors - please provide other sub-contractor references)
(Please do not include food or liquor vendors)
1. Name Phone Number City, State Type of Product Purchased Account Number
_(______)______________ _____________________________________________________________________________
2. Name Phone Number City, State Type of Product Purchased Account Number
__(______)______________ _____________________________________________________________________________
3. Name Phone Number City, State Type of Product Purchased Account Number
(_______)______________ ______________________________________________________________________________
4. Name Phone Number City State Type of Product Purchased Account Number
(_______)______________ _______________________________________________________________________________
TERMS OF AGREEMENT
This agreement shall apply to future credit and any existing debt owed by the undersigned to R.W. Smith & Co. (RWS). RWS is authorized to inquire of our bank and trade references to evaluate and update our credit worthiness. I/We release
and hold RWS harmless from any liability which may result from the disclosure of credit rating information. If this agreement is presented via facsimile, it will be considered the equivalent of an original document. If credit terms are extended in
reliance on the information contained herein, I/we agree to the following: (1) To pay RWS for purchases according to RWS standard terms of net 30 days from invoice date. (2) To pay RWS service charges of 1½% per month on any amounts
not paid according to terms. (3) To pay RWS reasonable attorneys' fees and costs incurred in connection with the enforcement of this agreement. If a lawsuit is commenced, I/we agree such lawsuit may be brought in a court of competent
jurisdiction in San Diego County, California and waive the right to any other jurisdiction or venue.
Signature Printed Name Title Date
PERSONAL GUARANTY
In consideration of the extension of credit by the Seller herein to Buyer herein, the undersigned does jointly and severally personally guaranty to pay and be responsible for payment of all sums, balances and accounts due Seller by Buyer,
including collection charges and/or attorneys' fees. This shall be an unconditional and continuing guaranty and shall continue in force notwithstanding any change in the form of such indebtedness, or renewals or extensions granted by Seller,
without obtaining any consent thereto, and until expressly revoked by written notice from me/us actually received by Seller. Any such revocation shall not in any manner affect my/our liability as to any indebtedness existing prior thereto. I/we
hereby waive notice of the acceptance of this agreement, notice of default or non-payment and waive action required by any statute against the buyer. No delay on Seller's part in exercising any right hereunder, or taking any action to collect or
enforce payment of any obligation hereby guaranteed, either against the Buyer or any other person primarily or secondarily liable with the Buyer, shall operate as a waiver of any such right or in any manner prejudice Seller's rights against me/us.
I/we agree that in the event of any default at any time by said Buyer, Seller shall be entitled to look to me/us immediately for full payment without prior demand or notice. I/we specifically agree to the venue and facsimile provisions set forth
above. This guaranty is personal to the signer. Any notation of corporate capacity is for information only and shall not affect the personal nature of the guaranty. Guarantors hereby subordinate all rights of reimbursement of guarantors from
principal debtor to RWS' rights to recover from principal debtor and guarantors. I, the undersigned, consent to R.W. Smith & Co. obtaining a consumer credit report on me in connection with this application for business credit.
Signed Date Signed Date
_________________________________________________ __________________________________________________
Printed Name Printed Name
CONTINUED OVER
CredApp 12061
IF PREFERRED, YOU MAY ATTACH YOUR PERSONAL OR CORPORATE FINANCIAL STATEMENT
PERSONAL FINANCIAL STATEMENT
ASSETS AMOUNT LIABILITIES AMOUNT
Cash on Hand Accounts Payable
Cash in Banks (Detail) Notes Payable Banks
Accounts Receivable Installment Contracts & Chattel Mortgages
Notes Receivable
Supplies Income Tax Payable
Listed Securities (Itemize Separately) Other Unpaid Taxes & Interest
TOTAL CURRENT ASSETS Other Liabilities (Current)
Unlisted Securities(itemized Separately)
Real Estate Buildings (itemize)
Mortgages and Trust Deeds - 1st
Mortgages and Trust Deeds - 2nd Mortgages or Liens on Real Estate
Automobiles Loans Payable after One Year
Due from Relatives Loans on Life Insurance
Cash Surrender Value- Life Insurance
Personal Furniture and Appliances TOTAL LIABILITIES
Office Equipment and Furnishings
Other NET WORTH
ANNUAL INCOME and Annual Expenses (excluding ordinary living expenses)
Salary Real Estate payment(s)
Salary (wife or husband) Rent
Securities Income Income Taxes
Rentals Insurance Premiums
Other (describe) Property Taxes
1 Other (describe - include Installment
2 payments other than real estate)
3 1
4 2
5 3
TOTAL INCOME TOTAL EXPENDITURES
LESS - TOTAL EXPENDITURES
NET CASH INCOME
(exclusive of ordinary living expenses)
I hereby reaffirm that the above Financial Statement is correct and true and that I have listed all my obligations and debts.
Date _________________________________________________________ Signature _____________________________________________
Printed Name __________________________________________
IF PREFERRED, YOU MAY ATTACH YOUR PERSONAL OR CORPORATE FINANCIAL STATEMENT