Fillable Credit Account Agreement (Los Rios Community College District)

Fill Online, Printable, Fillable, Blank Credit Account Agreement (Los Rios Community College District) Form

Use Fill to complete blank online LOS RIOS COMMUNITY COLLEGE DISTRICT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Credit Account Agreement (Los Rios Community College District)

On average this form takes 27 minutes to complete

The Credit Account Agreement (Los Rios Community College District) form is 6 pages long and contains:

  • 0 signatures
  • 43 check-boxes
  • 87 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Los Rios Community College District

BROWSE LOS RIOS COMMUNITY COLLEGE DISTRICT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Credit Account Agreement
Confidential: Follett Credit Account Form, Agreement & Application
1
To establish an account with Follett Higher Education Inc. (Follett), please provide the following information and the
authorizing signature permitting the release of information to Follett necessary to establish an account with your locally
operated Follett bookstore. Any and all information/data provided in conjunction with the application will be kept
confidential and used only as a basis for granting and administering credit under the account(s) applied for in this
application. By signing this agreement/application, the signature represents and warrants that the signer/applicant is
authorized to enter into this agreement with Follett on behalf of the entity/organization/campus named below.
I: ACCOUNT RELATIONSHIP TYPE: (check one)
UNIVERSITY/CAMPUS
GOVERNMENT
OTHER THIRD PARTY
II: CREDIT APPLICANT AUTHORIZED CONTACT INFORMATION:
A. Entity/Organization/Campus Contact Information
LEGAL ENTITY NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
EMAIL:
PHONE:
PHONE EXT:
FAX:
B. Entity’s Account Contact Information
*Check if Account Contact address is the same as the legal entity name. If different, fill out below:
ACCOUNT CONTACT NAME:
*ADDRESS:
*CITY:
*STATE:
*ZIP CODE:
EMAIL:
PHONE:
PHONE EX
T:
FAX:
C. Entity’s A/P Account Contact Information
*Check if A/P Contact address is the same as the legal entity name. If different, fill out below:
A/P ACCOUNT CONTACT NAME:
*ADDRESS:
*CITY:
*STATE:
*ZIP CODE:
Credit Account Form/Agreement/Application
Confidential: Follett Credit Account Form, Agreement & Application
2
EMAIL:
PHONE:
PHONE EXT:
FAX:
III: TAX INFORMATION REQUIREMENTS
Tax ID (FEIN):
Tax exempt status:
Exempt (Complete section(s) below)
1.
Select the type of exemption being claimed:
Resale Exemption (If selected, provide a copy of the resale certificate (s) and add the information below.)
State: Resale ID/#:
Tax Exempt Organization (If selected, complete section 2 below.)
2.
Tax exempt organizations: Will the exempt organization retain possession of the items purchased?
Yes (If selected, provide a copy of your exemption certificate and add information below)
State: Exemption#
No (If selected, the purchase will not be tax exempt.)
3.
In general, most states require that the exempt organization be the direct purchaser and payer of record (i.e.
Not a 3rd party payer) in order to qualify for the sales tax exemption.
4.
Some exceptions to this general rule do exist (i.e. FL), which will be addressed by our tax department on a case
by case basis. If this applies to your situation, provide a copy of your exemption certificate and complete the
information below. This information will be used by our tax department to validate the tax exemption claim. State:
Exemption#
As
required by law, Follett will collect sales tax in every state applicable for Follett purchases. All sales in store and
online for pickup or shipment
will be taxed unless valid tax exemption documentation has been provided/verified or
the shipping address
is in a state with no state sales tax.
The undersigned certifies that the items purchased
as tax-exempt will be used for official business of the above
named organization or agency. I accept
liability for the taxes and any applicable penalty or interest if the purchase
for the organization/agency purchase
is found to not qualify for the exemption or if the information asserted in this
form is deemed fraudulent.
The undersigned further asserts that they have the authority to complete and submit this document
on behalf of the
above named
entity.
Signature:
Printed Name:
Title:
Date:
Credit Account Form/Agreement/Application
Confidential: Follett Credit Account Form, Agreement & Application
3
IV: INFORMATION RELATED TO ACCOUNT SETUP AND CHARGE CONDITIONS
ACCOUNT INFORMATION:
ACCOUNT NAME:
DESCRIPTION:
TERM START DATE FOR PURCHASES (not to
exceed start of academic year):
TERM END DATE FOR PURCHASES (not to exceed
end of academic year):
BUDGET/FUNDING # (if applicable):
PO# (if applicable):
AUTHORIZED LIMITS OF CHARGES:
ACCOUNT CHARGE $ AMOUNT LIMIT OF OVERALL ACCOUNT:
INDIVIDUAL CUSTOMER ACCOUNT CHARGE LIMIT PER PERSON:
Individuals (students IDs, faculty IDs, staff IDs, etc.) listed as follows are authorized to charge to this account for the
current specified term/academic year period. Failure to provide documentation of “individual” names as cited at the
time of application will require additional documentation issued to the student, which may include a voucher issued
from the entity with authorized signature. The account authorizer is solely responsible for reimbursing Follett for any
purchases pursuant to such vouchers and costs of any collection efforts. If additional space is required other than
page 3, attach documentation to application following the same format.
CUSTOMER ACCOUNT INFORMATION:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST: ID#: CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
FIRST:
LAST:
ID#:
CHARGE LIMIT:
Credit Account Form/Agreement/Application
Confidential: Follett Credit Account Form, Agreement & Application
4
ACCOUNT RESTRICTIONS (if applicable):
Restrictions (Are items NOT allowed for purchase on this account?)
YES
NO
If Yes: Check the boxes below to indicate the departments that are NOT allowed to be purchased with this account.
NOTE: All financ
ial aid accounts are available online unless a written notice is provided by the campus. For any
major account online, identify below and contact the store manager to further clarify specifics. Failing to identify
restrictions, if applicable, denotes that all transactions within the categories are acceptable and will be promptly paid
when billing is presented.
100 Used Text 520 Children’s Clothing Campus Logo
110 Used Course Packs 530 Logo Accessories (backpacks, headwear)
200 New Text 600 Gifts/Campus Logo
210 New Course Packs 700 Convenience/Grocery (food & beverage)
220 Digital Format Text 710 Health & Beauty Care
230 Course Adopted Supplies 720 Graduation Products, Cap and Gown, Diploma
Frames
300 General Books 730 Audio/Visual
310 Magazines/Newspapers 780 School Specific Programs
330 Non-Emblematic Accessories 800 Computer Software/License
360 Greeting Cards 810 Computer and Cell Phone Supplies/
Accessories & Phone Cards
400 Supplies/School Supplies 820 Computer Software/License Media
410 Imprinted/Campus Logo
Supplies
830
Computer and Hardware & T-Mobile Cell
Phone and Phone Cards
430 Central Office Supplies 840 Computer Peripherals
490 Course-Related Supplies 900 Operational & Print Supplies
500 Men’s & Unisex Clothing
Campus Logo
910 Non-Merchandise SKU’s (fees/charges/service
such as postage, campus tickets, parking, etc.)
510 Women’s Clothing Campus
Logo
920 Text Rental Fees
Credit Account Form/Agreement/Application
Confidential: Follett Credit Account Form, Agreement & Application
5
V: ADDITIONAL AUTHORIZATIONS:
ACCOUNT CHANGES:
Applicant/Entity is responsible for any and all authorized purchases including bulk rental and alternate collateral
processes made by an authorized charger, regardless of any change in the authorized charger’s employment or
financial aid eligibility or enrollment status, unless applicant has notified the bookstore in writing in advance of the
purchases that the authorized charger is no longer authorized to make purchases on the account.
RENTAL (University/Campus Only):
If the account is for a bulk rental program, the Applicant/Entity must provide additional information along with the
submission of this application: (1) the name of the student or group of students authorized to rent and (2) the
corresponding charge limit amount for each type of authorized rental. The Applicant guarantees payment to Follett
Higher Education for replacement value of any unreturned, damaged, lost or stolen rental books plus any and all
unreimbursed applicable fees as outlined in the rental agreement.
REFERENCES (Third Party Only):
Applicant authorizes verification of bank, trade references and reporting agencies to release any reports to Follett for
purposes of evaluating credit worthiness of its applicant. Applicant will provide Follett with a statement of its financial
condition if Follett requests a statement. Applicant further authorizes Follett to use any information provided by the
applicant pursuant to this agreement for the purpose of administering the applicant’s account (s).
Bank
Name:
Account:
VI: PAYMENT INFORMATION AND TERMS:
PAYMENT METHODS:
Payment via lock box check or electronic payment (wire/ACH) is preferred payment methods to ensure security and
prompt application of payments to accounts. Applicant agrees to provide all applicable information within the payment
remittance advice (including invoice #, store #, major account #, etc.) as part of the lock box/electronic remittance
documentation. In addition for electronic remittance, the comment/reference field of the bank transfer must include
store # and invoice #.
PAYMENT TERMS:
Applicant agrees to be bound by the terms of the credit governing the account (s). Applicant will receive an invoice
each month/predetermined period for the charges made to Applicant’s account by authorized signers. Payment is
due net thirty days from the date of the invoice. Disputes on any invoice must be reported to Follett within thirty days
from the invoice date.
PAYMENT TERMS UNIVERSITY/COLLEGE/CAMPUS:
In addition to the above payment terms, r
eference Campus Contract with Follett for terms and conditions. Commission
payable to the university/college will be withheld for A/R charges that are more than 6
0 days in arrears. Application of
the commission to A/R will occur after 90 days instead of payment of commission.
LATE FINANCE CHARGES/ACCOUNT ON HOLD:
Late payments will be subject to a monthly finance charge of 1.5%. Follett may place all or any one of the applicant’s
accounts on hold in the event late payment and pursue collection for delinquent balances. To the extent permitted by
applicable law, the Applicant will be liable for any costs and attorneys’ fees incurred by Follett as a result of such
collection. The laws of the State of Illinois will govern this agreement.
Credit Account Form/Agreement/Application
Confidential: Follett Credit Account Form, Agreement & Application
6
VII: AUTHORIZATION AND AGREEMENT TO ACCOUNT TERMS
Applicant authorizes Follett to use any information provided by the Applicant pursuant to this agreement for the
purpose of administering the Applicant's account (s). In creating and handling accounts hereunder, Follett
assumes none of the Applicant’s responsibilities under federal or state laws that govern the creation and
administration of student financial aid programs. Applicant acknowledges that it is solely responsible for
complying with trust, record keeping, accounting, and distribution requirements of such laws and, to the extent
permitted by applicable law, will indemnify Follett against any claims resulting for applicant’s non-compliance.
APPLICANT’S SIGNATURE:
DATE:
CAMPUS AGREEMENT OF ACCOUNT SETUP (UNIVERSITY/CAMPUS
ACCOUNTS ONLY):
By signing below, the college/university approves the creation of this account
and has verified the information provided. The college/university is responsible
for payment in the occurrence of non-payment of the department.
CAMPUS REPRESENTATIVE SIGNATURE: DATE:
FOLLETT HIGHER EDUCATION, STORE MANAGER APPROVAL:
DATE:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Credit Account Agreement (Los Rios Community College District)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document