Credit Application

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CREDIT APPLICATION - COUNTRY

Please fill out the form and include dealer ID 534

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CREDIT APPLICATION - TERMS

Untitled(Required)

This application is made to Interstate Billing Service (IBS) for the purpose of obtaining an IBS credit account, operated by IBS and Bank Independent (BI). By signing this application, the applicant, by and through its duly authorized officer signed below, in addition to the principal named below (collectively “I”, “We”, “Our” or “Us”) warrant that: all of the information submitted is true; he/she is authorized to request credit for the company and sign/submit this application; We are able to meet Our financial obligations; and We will remit payments in accordance with the invoice terms. We understand that IBS/BI complies with Section 326 of the USA Patriot Act which mandates the verification of certain information about Us while processing Our account application requesting a 30 day account. We authorize IBS/BI to check credit references and the information on this application and to obtain (a) consumer credit reports on Our personal credit history if necessary, in accordance with the Federal Fair Credit Reporting Act, and/ or (b) commercial credit reports to check Our credit standing, for this application or for the update of Our credit file. IBS may require CPA Reviewed or Audited Financial Statements during the credit review. We hereby direct creditors named in the application to release to IBS/BI information with regard to Our financial condition as may reasonably have a bearing on this application. We acknowledge that this application is subject to approval and acceptance by IBS/BI in Alabama, and that by failing to sign this application, We will not be considered as a candidate for credit. A credit guideline may be established at IBS/BI discretion. We agree to pay any collection costs incurred to collect the unpaid balance, including interest on the unpaid balance, as allowed by state law, and reasonable attorneys’ fees. We agree not to assert any claims or defenses against the accounts purchased by IBS from any client including right of offset against invoices purchased by IBS/BI. Submission of payment acknowledges agreement to the terms and conditions set forth by IBS. This agreement shall be governed by and construed according to the laws of the State of Alabama. We submit to the jurisdiction of any Alabama State or Federal Court sitting in the Northern District of Alabama over any action arising hereunder and agree that all claims will be brought in such Alabama State or Federal Court. We further waive any objection on the basis of forum non-conveniens. Nothing in this paragraph shall affect the right of IBS to set or enforce any conditions. All invoices billed to approved accounts are assigned to IBS. Make checks payable to the vendor(s) or IBS. Please mail all payments to Interstate Billing Service, PO Box 2208, Decatur, AL 35609-2208. Payment terms will be reflected on the monthly statement and/or invoice. If Our business should sell or close, it is Our responsibility to advise IBS/BI immediately.

CREDIT APPLICATION - TERMS

Untitled(Required)

I/We warrant that all of the information is true. I/We affirm that I am/we are financially able to meet my/our obligations, and will remit in accordance with the invoice terms. I/We hereby authorize all of the persons or companies named in this application to release to Interstate Billing Service, Inc. (IBS), or its representatives, such information with regard to my/our financial condition as may reasonably have a bearing on this application. I/We authorize IBS to obtain a consumer credit report on my/our personal credit history if necessary, and to use this report in making decisions concerning my/our credit worthiness for a 30-‐day account. I/We understand a personal guaranty may be required. If I/we refuse to sign this application, I/we will not be considered as a candidate for credit with IBS. A credit guideline may be established at IBS’ discretion. I/We agree to pay any collection costs incurred to collect the unpaid balance of accounts purchased by IBS, including interest on the unpaid balance, as allowed by state law, and any reasonable attorney’s fees. I/We agree to pay in full all our accounts purchased by IBS and not to assert any claims or defenses with respect to such accounts, including any right to offset. Receipt of payment acknowledges agreement to the terms and conditions set forth by IBS. This agreement shall be governed by and construed according to the laws of the State of Alabama. I/We submit to the jurisdiction of any Alabama State or Federal Court sitting in the Northern District of Alabama over any action arising hereunder and agree that all claims will be brought in such Alabama State or Federal Court. I/We further waive any objection on the basis of forum non-conveniens. Nothing in this paragraph shall limit the right of IBS to bring any action or proceeding in courts of other jurisdictions. I/we understand that my/our accounts have been assigned to IBS, agree to make cheques payable to the vendor(s) and to mail all payments c/o Interstate Billing Service, C/O T04220C, PO Box 4220, STN A, Toronto, ON M5W 3B9. Payment terms will be reflected on the monthly statement and/or invoice. If my/our business should sell or close, I/we will advise IBS immediately. The undersigned represents and warrants that he/she is authorized to request credit for the Applicant named above and to sign/submit this application.

CREDIT APPLICATION - COUNTRY

CREDIT APPLICATION - TERMS

CREDIT APPLICATION - TERMS

Contact

Business Details

Home Office

Please List Company Owners and Officers

Bank Information

30-Day Trade References

Attachments (Corporate trade sheet, balance sheet, etc)

Financial Information

IBS Information

Guarantors

Signature

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