All-State Industries | On Line Credit Application

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GENERAL INFORMATION - ** Indicates Required Field

This application will be time stamped: -

Business Name:

Your Name:

Email:**

FOR SECURITY PURPOSES AND TO PREVENT SPAM PLEASE ENTER YOU EMAIL ADDRESS AGAIN!

Email:**

Billing Address:

City:

State:

Zip:

Phone:

Fax:

How Long Here:

Shipping Address:

City:

State:

Zip:

Former Business Address (if applicable)

Doing Business As:

Parent Company:

Type of business:

Sole Owner:

Partnership:

Corporation:

LLC:

LLP:

D & B #:

Fed ID #:

State INCORP in:

Year Established:

Not for Profit:

Line of credit requested $:

Legal Entity

Payment Responsibility:

Phone:

Fax:

Street Address:

City:

State:

Zip:

Registered Agent:

State INCORP in:

FEIN#:

List all owners/Partners, officers or other principals:

Name/Title (1):

Name/Title (2):

Home Street Address:

City:

State:

Zip:

City:

State:

Zip:

Soc.Sec. #:

Phone:

Soc.Sec. #:

Phone:

Name/Title (3):

Name/Title (4):

Home Street Address:

City:

State:

Zip:

City:

State:

Zip:

Soc.Sec. #:

Phone:

Soc.Sec. #:

Phone:

Has The Firm Or Any Of Its Principals Ever Filed Bankruptcy?

Yes

Date of filing:

If yes, explain: (Please use the text field below and provide as much detail as possible)

REFERENCES

Bank References

Bank Name (1):

Bank Name (2):

Account #:

Account Type:

Checking:

Savings:

Loan:

Account Type:

Checking:

Savings:

Loan:

Bank Officer:

Phone:

Trade References

Company Name (1):

Company Name (2):

Phone:

Fax:

Phone:

Fax:

Street Address:

City:

State:

Zip:

City:

State:

Zip:

Email Address:

Company Name (3):

Company Name (4):

Phone:

Fax:

Phone:

Fax:

Street Address:

City:

State:

Zip:

City:

State:

Zip:

Email Address:

CONTACT INFORMATION

Will you accept invoices via fax?

Yes

Via Email:

Yes

Fax:

Email:

Fax to whose attention:

Accounts payable contact:

Contact's phone number & ext:

Are purchase order numbers required on your invoices?

Yes

Note: Sales tax will be added to all purchases unless your signed Tax Exemption Certificate is on file with us. Tax Exempt: Yes No (If yes please provide a copy)

This document conforms to the Electronic Signatures in Global and National Commerce Act passed by Congress in 2000.

STANDARD TERMS ARE NET 30 DAYS OR 1% NET 10 DAYS AND ARE STATED ON EACH INVOICE. MERCHANDISE RETURNS WILL NOT BE ACCEPTED WITHOUT A RETURN GOODS AUTHORIZATION FROM ALL-STATE INDUSTRIES INC. AND MAY BE SUBJECT TO A RESTOCKING CHARGE. A TIME LIMIT OF 6 MONTHS FROM DATE OF PURCHASE WILL BE ENFORCED FOR ANY CLAIMS AGAINST ALL-STATE INDUSRIES INC. FOR MISSHIPMENTS, SHORTAGES, OR PROBLEMS THAT MAY ARISE FROM YOUR ORDER. RECOVERY FOR SUCH CLAIMS WILL BE LIMITED TO THE PRICE OF THE DEFECTIVE MATERIALS.

APPLICANT’S E-SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY, AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH THE INVOICE TERMS. APPLICANT SHALL BE BOUND BY ALL TERMS ON THE INVOICE AND ALL-STATE INDUSTRIES INC. SALES POLICY. NO ASSIGNMENTS SHALL BE PERMITTED WITHOUT THE WRITTEN CONSENT OF ALL-STATE INDUSTRIES INC.

ANY LEGAL PROCEEDINGS ARISING OUT OF ANY CONTRACT MADE OR DEALING BETWEEN THE PARTIES MAY BE PROCESSED AND SUBMITTED TO A COURT IN THE STATE OF IOWA AND BE GOVERNED BY THE LAWS OF IOWA AND WE AGREE TO THIS VENUE IF THE CREDITOR REQUESTS. SERVICE OF ANY PROCESS INCLUDING SUMONS AND COMPLAINTS MAY BE MADE BY REGISTERED MAIL TO EITHER PARTIES ADDRESS AS INDICATED IN THIS APPLICATION.

WE FURTHER UNDERSTAND AND AGREE THAT INTEREST AT THE RATE OF 18% PER ANNUM OR THE MINIMUM AMOUNT ALLOWED BY LAW MAY BE ASSESSED ON ANY OUTSTANDING BALANCE OWED IF NOT PAID ACCORDING TO THE TERMS AS STATED ON THE INVOICES. WE FURTHER AGREE TO PAY ANY REASONABLE ATTORNEY FEES AND COSTS INCURRED IN THE COLLECTION OF ANY AMOUNT NOT PAID WHEN DUE TO ALL-STATE INDUSTRIES INC.

THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE. WE HEREBY AUTHORIZE ALL-STATE INDUSTRIES INC. TO INVESTIGATE THE REFERENCES LISTED PERTAINING TO MY/OUR CREDIT AND FINANCIAL RESPONSIBILITY.

By selecting the submit button below you agree to the e-signature terms that apply to electronically submitted forms.

If your application for business credit is denied, you have the right to a written statement of specific reasons for denial. To obtain the statement, please contact the credit manager of All-State Industries Inc. within 60 days from the date you are notified of our decision. We will send you a written statement of the reasons for denial within 30 days of receiving your request for the statement.