Fillable APPLICATION CREDIT CARD/CHECK ACCEPTANCE

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APPLICATION CREDIT CARD/CHECK ACCEPTANCE

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CREDIT CARD/CHECK ACCEPTANCE
APPLICATION
0DQVILHOG$YHQXH6XLWH
Pittsburgh, PA 15220
412-921-8330 800-425-2760 (Billing) FAX: 412-921-4333
Company Name
Street Address
City
Date of Application
Phone No. Fax #
County Zip
Person to Contact in Case of Questions
Taxable
E-mail
Tax Exemption #
Yes No
If Non-Taxable, please enclose a copy of your Tax Exemption Certicate.
Please indicate your Company’s purchasing rules:
1 Must have purchase order.
2 Must have shipping address.
3 Call for approval.
4 Purchase by _________________________________only.
5 No back orders.
6 Call on purchases over $______________.
7 Special instructions ____________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Owners, Partners or
Ofcers Names
Title
% of
Ownership
Home Address Home Phone
1
2
3
Date Founded Years at Present Location
Own
Lease
Rent

Individual
 Partnership
 Corporation
Type of
Business
State
of:
________________________
Parent Corp. Date Incorporated
Nature of Business
Amount of
Credit
Desired
Estimated
Annual
Requirement
Annual
Sales
Volume
Accounts
Payable
Contact Person
$
ALARMAX USE ONLY
Bank Name
Date _____________________ Approval ____________________
Account # ______________________________________________
Credit Line _____________________________________________
Credit Terms ____________________________________________
Address
Phone No. Contact Person
Type of
Account
& No.
Bank Name
Address
Phone No. Contact Person
Type of
Account
& No.
Checking ____________________________
Savings _____________________________
Loan _______________________________
Checking ____________________________
Savings _____________________________
Loan _______________________________
1
2
Click any eld to enter text; then Print
Legal Composition of Business Banking References
Principals/Ofcers
Tax Payer/I.D.#
State
AlarMax Branch
Acknowledgement and Agreement to the Following Terms and Conditions of Sale:
Payment Terms: In consideration of your supplying products on open account credit terms, it is understood this
account is to be paid in full on terms of C.O.D. I agree that, should I fail to fulll any of the obligations under this
credit agreement, fail to comply with any payment terms, or in the event any check be dishonored by my bank for
any reason, or any trade/acceptance note not be paid when due, then the entire balance owing on this account
will become due and immediately payable and any credit limitation established will be withdrawn. Upon such
fault, I further agree to pay any and all service charges legally applied to the indebtedness due.
Warranty: AlarMax provides no warranties of any kind, either express or implied. Individual products may carry
manufacturer’s warranties. AlarMax is not a party to these warranties (if any) and delivers these products with
warranty solely on a pass-through basis.
Guarantee: I/we agree to bind myself/ourselves that l/we will personally guarantee payment of this account. The
guarantor(s) hereby agree to pay all purchases within the payment terms of C.O.D. and to pay an added service
charge of 1½% per month on all delinquent invoices or portion thereof until paid (or the legal maximum allowed
in the buyer’s state). The guarantor(s) further agree that if the account is placed in the hands of an attorney for
collection or collection agency due to a past due condition, the guarantor(s) hereby agree to pay all collection fees
and/or attorney fees plus court costs (if any). These terms and conditions shall be governed by and construed in
accordance with the laws of the Commonwealth of Pennsylvania.
The undersigned hereby agrees to the above terms and conditions of sale and certies that the information
submitted is true and correct and the information furnished is a true and accurate statement of the nancial
condition of the company as of the undersigned date. The undersigned also authorizes the listed banking
references to respond fully when AlarMax contacts them in connection with this APPLICATION for C.O.D. account.
Date _____________________ Authorized Signature: _____________________________________
SS# ______________________________________
Authorized Signature: _____________________________________
SS# ______________________________________
Consideration for an increase or establishment of a C.O.D. account will be given upon receipt of this
completed and signed application.
In the event my account goes out of terms, AlarMax has my authorization to apply charges on the
following VISA/MasterCard/Discover/American Express account (circle one).
PRINT the form, then ll out the remaining information below.
Account # Authorized Signature
______________________________ ____________________________________________
*Copy of Credit Card and Photo ID Required Before Application Will Be Processed
Please Submit Your Application Today — We Will Begin Processing It Immediately!
CVV Code Exp. Date
______________________________ ________
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APPLICATION CREDIT CARDCHECK ACCEPTANCE

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Completed 21 April 2022

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