RANKIN
HISTOLOGY SUPPLY SPECIALISTS
HISTOLOGY SUPPLY SPECIALISTS
Credit Application
10399 Enterprise Dr. Davisburg, MI 48350
Submit completed form to: orders@rankinbiomed.com
Company Information
[Enter Legal Company Name]
[Enter Legal Address]
[Enter Contact Name]
[Enter Title]
[Enter Billing/Statement Address]
[Enter City]
[Enter State]
[Enter Zip]
[Enter Accounts Payable Contact Name]
[Enter Phone Number]
[Enter Fax Number]
[Enter Email Address]
[Enter Website Address]
[Enter Federal Tax ID]
Business Information
[Enter DBA or Business Trade Name]
[MM/YYYY]
[Enter Amount]
[Enter Principal Owner(s) or Stockholder(s)]
[Enter Address of Principal Owner/Officer]
[Enter City]
[Enter State]
[Enter Zip]
[Enter % Ownership]
[Enter Title]
References
| Primary Bank/Financial Institution | Account Number | Contact Name | Phone |
|---|---|---|---|
| [Enter Bank Name] | [Enter Account Number] | [Enter Contact Name] | [Enter Phone Number] |
| Vendor #1[Enter Vendor Name] | [Enter Account Number] | [Enter Contact Name] | [Enter Phone Number] |
| Vendor #2[Enter Vendor Name] | [Enter Account Number] | [Enter Contact Name] | [Enter Phone Number] |
| Vendor #3[Enter Vendor Name] | [Enter Account Number] | [Enter Contact Name] | [Enter Phone Number] |
Terms and Conditions
I (We) hereby authorize you or any credit reporting agency engaged by you to investigate the references herein listed or to investigate my (our) personal credit and financial records including my (our) banking records. I (We) hereby certify that I (We) have read this form thoroughly and accept its conditions, and further state that all information supplied by me (us) is true in fact and intent.
- Terms are Net 30.
- All past due accounts shall bear interest at the rate of 1.5% per month or 18% per annum.
- All short shipments must be reported immediately upon receipt of goods.
- Merchandise may only be returned with prior authorization from the seller.
- Title to the goods, and the proceeds thereof, shall remain with the Seller until such time as the account is fully paid.
- Cancellation: The Seller reserves the right to cancel this credit agreement at any time without prior notice to the Applicant.
- Credit Investigation: The Applicant and undersigned officer shall provide to the Seller such financial information as may be requested, and consents to the verification of all information contained herein (or further information which may subsequently be provided), including any personal information as may be deemed necessary. All credit references indicated are hereby authorized to provide any information regarding the Applicant and undersigned officer that may be requested by the Seller or its Agent.
- This agreement shall be governed by the laws of the State of Michigan and, in the event of default, jurisdiction shall be that of the seller.
[Signature Area]
[Enter Print Name]
[Enter Title]
[Enter Date]
