Credit Application
TPH Holdings LLC 10321 Fortune Pkwy Bldg. 400 Jacksonville FL 32256 Ph: 904-731-3034 Fax: 904-730-7747 *Revised 8/15/2015
BUSINESS INFORMATION
Legal Name
Sole proprietorship Partnership
Corporation
How Long in business? _______________
DBA Company Name
Billing Address
City, State, Zip
Phone
Shipping address Same
Fax
City, State, Zip
Federal ID #
Email
Tax Exempt #
Electronic Statement?
Yes No Emailed or Faxed
OWNER AND BANKING INFORMATION
Owner/Officer
Bank Name
SS #
City, State, Zip
Title
Phone
Address
Contact name
City, State, Zip
Account #
Phone
Savings Checking
BUSINESS/TRADE REFERENCES
1. Company name
Phone
City, State, Zip
Fax
Account #
Terms
2. Company name
Phone
City, State, Zip
Fax
Account #
Terms
3. Company name
Phone
City, State, Zip
Fax
Account #
Terms
AGREEMENT
The undersigned authorizes and releases all banks, persons and companies listed on this application to furnish information to authorize the
checking of credit. The undersigned agrees to pay all collection costs, court costs, and legal fees incurred to collect delinquent balances.
Outstanding balances are subject to 1.5% per month interest.
SIGNATURE *OWNER, PARTNER OR COPORATE OFFICER ONLY
Signature
Title
Print
Date
PERSONAL GUARANTEE *OWNER, PARTNER OR COPORATE OFFICER ONLY
In consideration for credit extended, the undersigned contracts and guarantees to the faithful payment, when due, of all accounts of the
company seeking credit from the date of this application. The undersigned expressly waives all notice of acceptance of this guarantee,
notice of extension of credit, presentment of demand for payment and any notice of default by the company seeking credit and all
other notices the guarantor might be entitled to. Revocation of the guarantee shall be in writing and delivered by certified mail.
Signature
Title
Print
Date
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