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CONFIDENTIAL CREDIT APPLICATION
1 (800) 422-2444; (818) 566-9898; FAX: (818)
566-8989
Videotape Products, Inc., 2721 W. Magnolia Blvd., Burbank, CA 91505 |
| DATE |
CUSTOMER I.D. NUMBER |
SALESPERSON |
| CUSTOMER/ACCOUNT NAME |
FEDERAL I.D. NUMBER |
| ADDRESS |
TELEPHONE
( ) |
| ADDRESS |
TELEPHONE
( ) |
| CITY
STATE
ZIP
GENERAL E-MAIL |
| ACCOUNTS PAYABLE CONTACT |
TELEPHONE
( ) |
| BUYER NAME |
BUYER E-MAIL ADDRESS |
TELEPHONE
( ) |
AMOUNT OF CREDIT
REQUESTED TERMS REQUESTED
$
[ ] NET 30 DAYS [ ] C.O.D. [
] OTHER__________________________ |
OWNERSHIP
[ ] Public Corp. [ ] Closed Corp. [ ]
Partnership [ ] Proprietorship [ ] Non-Profit
Organization |
| Type of Business |
At Present Location
Since Date: |
Year Est. |
# Employees |
Listed with D&B
[ ] YES, D&B # |
| NAME (Proprietor, Partners, or Officers) |
TITLE |
SOCIAL SECURITY NUMBER |
| NAME |
TITLE |
SOCIAL SECURITY NUMBER |
| NAME |
TITLE |
SOCIAL SECURITY NUMBER |
References: For open accounts we require 3
Trade References that you purchase from on open account, that maintain a high credit or
limit matching the line of credit you are requesting, plus the Bank Reference. For
C.O.D. Check on Delivery accounts we require 1 trade reference and the Bank
Reference. To avoid delays, please provide all requested information. |
|
|
| 1 |
NAME
TELEPHONE
FAX
( )
(
) |
| ADDRESS |
| CITY
STATE
ZIP |
| 2 |
NAME
TELEPHONE
FAX
( )
(
) |
| ADDRESS |
| CITY
STATE
ZIP |
| 3 |
NAME
TELEPHONE
FAX
( )
(
) |
| ADDRESS |
| CITY
STATE
ZIP |
|
| BANK
BRANCH |
| ADDRESS |
| CITY
STATE
ZIP |
|
TELEPHONE (
)
FAX (
) |
ACCOUNT
NUMBER ______________________________________________
[ ] CHECKING [ ]
SAVINGS [ ] LOAN |
| BANK CONTACT |
|
|
|
COMPLETE THIS NEXT SECTION IF YOU ARE A
RESELLER |
FIRM NAME_______________________________________________________________________________________
I HEREBY CERTIFY,
that I hold valid seller's permit
no.__________________________________________________________________
issued pursuant to the sales and use tax law; that I am engaged in the business of
selling
_________________________________________________________________________________________________
that the tangible personal property described herein checked below which I shall
purchase from
VIDEOTAPE PRODUCTS INC., will be resold by me in the form of tangible
personal property, PROVIDED,
however, that in the event any of such property is used for any purpose other than
retention,
demonstration, or display while holding it for sale in the regular course of
business, it is understood
that I am required by the retail sales tax act to report and pay the tax, measured
by the purchase price of
such property.
Description of property to be purchased.
[ ] VIDEO AND
[ ] VIDEO
[
] CCTV [
] COMPUTER [ ] OTHER
AUDIO TAPE
EQUIPMENT EQUIPMENT
SUPPLIES
____________________ |
|
DATE
AT |
THIS CERTIFICATE IS GOOD UNTIL REVOKED IN WRITING (Rubberstamp or typewritten signature
not valid)
PURCHASER SIGN HERE x |
ADDRESS
CITY
STATE ZIP
TELEPHONE
(
) |
|
ALL APPLICANTS: READ, SIGN AND DATE THIS NEXT
SECTION, AND NEXT PAGE |
IN CONSIDERATION of the extension of credit by VIDEOTAPE PRODUCTS INC. as requested
herein, I/we agree:
1. To pay at Burbank, California my/our account in full no later than 30 days after
the date of the invoice
reflecting charges made to said account, unless a different
payment agreement is entered into in writing
and is signed by VIDEOTAPE PRODUCTS INC.;
2. To pay interest on all past due amounts at the rate of ten percent (10%) per
annum;
3. To pay all costs, including reasonable attorney's fees and court costs, incurred
and/or expended by
VIDEOTAPE PRODUCTS INC. in collecting any amounts due on
my/our account;
4. To grant and hereby grant a security interest in all merchandise sold to me/us
hereunder and
acknowledge that title to all such merchandise shall remain
with VIDEOTAPE PRODUCTS INC. until the
entire unpaid balance is paid. Notwithstanding the
fact that title to the merchandise shall not pass to
me/us, I/we shall pay all taxes assessed against the
merchandise in my/our possession or under my/our
control and I/we assume the risk of loss or damage to such
merchandise from whatever cause;
5. I/we agree to furnish VIDEOTAPE PRODUCTS INC., upon request, my/our most recent
financial statement
and or personal guarantee; and
6. The foregoing shall apply to any and all purchases made pursuant to the credit
extended in accordance
with the request in this application.
I/we
acknowledge and agree that VIDEOTAPE PRODUCTS INC. is relying upon the information,
representations and statements contained herein and I/we expressly warrant and guarantee
that
the above is true and correct.
I/we
declare under penalty of perjury under the laws of
the
State of California that the foregoing is true and correct.
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SIGNATURE
TITLE
DATE
X |
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