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Credit Application

Company Name *

Company Phone *

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Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country

Is your mailing address the same as your billing address? *YesNo

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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Primary Contact Information

Name *

Phone *

Email Address *

Fax

About Your Company

Company Type *CorporationPartnershipSole ProprietorshipLLP/LLC

Company Website/URL *

State Registration Number *

State License Number *

Number of Years In Business *

Federal Tax ID *

Prefix

First Name *

Last Name *

Accounts Payable Phone *

Accounts Payable Email Address *

Principle

Prefix

First Name *

Last Name *

Street Address *

Apartment, suite, etc *

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Principle Role *OwnerPartnerCorporate OfficerMemberOther

Principle Email *

Bank Reference

Bank Name *

Street Address *

City *

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ZIP / Postal Code *

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Bank Phone *

Bank Fax *

Account Number *

Officer Contact

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First Name *

Last Name *

Officer Email *

Supplier References

Reference #1

Name *

Street Address *

Apartment, suite, etc

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Phone *

Fax *

Reference #2

Name *

Street Address *

Apartment, suite, etc

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ZIP / Postal Code *

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Phone *

Fax *

Reference #3

Name *

Street Address *

Apartment, suite, etc

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Agreement

Credit Terms

The preceding information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize AMI Recycling & Services to investigate all references and customary credit information sources including consumer credit reporting repositories regarding my/our credit and financial responsibility for the purpose of obtaining credit and for periodic review for the purpose of maintaining the credit relationship.

Terms of Sale

CONDITIONS: Payment terms are Net 30 days upon credit approval. Additional terms of sale including terms of payment and allowable discounts for each purchase are agreed to below as well as those specified on the face of each invoice. Balances carried past the due date or over established credit line will cause new orders to be held out of production. The customer hereby agrees to pay all collection and legal fees if such action be necessary, as well as I .5% per month / I 8% per annum interest on any past due invoices, or the maximum as allowed by the law, as well as any Non-sufficient fund charges as allowed by the law in the event of a returned check. Property and products sold in association with extending credit to the applicant remains under the ownership of creditor until fully paid for. I have read these conditions and hereby agree to them.

CHANGE OF OWNERSHIP: I/We understand that we must notify AMI Recycling & Services in writing and by certified mail of any change in ownership, the name of the business or structure of the business under which credit is established.

I/We certify that this request is for the extension of credit for business purposes only and not for the extension of credit for personal, family or household purposes.

Consent to Obtain Consumer Credit Report

The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

PERSONAL GUARANTEE

In consideration of credit being extended by AMI Recycling & Services to the above named applicant for merchandise/services to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor(s) hereby contracts and guarantees to AMI Recycling & Services the faithful payment, when due, of all accounts of said applicant. Payment shall be personally guaranteed irrespective of status or change in existing business of which the undersigned is a principal (owner, partner or officer).

In addition to guaranteeing full payment, the undersigned agrees to reimburse AMI Recycling & Services for any and all expenses incurred in the collection of said indebtedness, including, but not limited to, collection and legal fees, expenses and interest at the maximum legal rate permitted by law.

The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in the evaluation of this personal guarantee, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by the above named business credit graotor, from time to time as may be needed, in the credit evaluation process.

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act The federal agency that administers compliance with law concerning this credit is the Federal Trade Commission, Division of Credit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.

Applicant Company Name *

Prefix

First Name *

Last Name *

Owner/Officer Title *

Owner/Officer Social Security Number *

Date *

AMI Recycling

17710 US Hwy 41

Spring Hill, FL

For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.

John 3:16

 Call us: (352) 799-5828