2023 Credit Application

ANTICIPATED MONTHLY PURCHASES $*
COMPANY BUSINESS NAME*
Phone*
Fax*
Email*
Street/Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing / Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Accounts Payable Contact*
First Last
Phone
AP Fax
Email
HOW WOULD YOU PREFER TO RECEIVE INVOICES*
- Fax
- E-mail
PO REQUIRED?*
- Yes
- No
TAXABLE?*
- Yes
- No
(IF NO, PROVIDE RESALE CERTIFICATE)
ATTACH RESALE CERTIFICATE
Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.
Date Business Started:*
MM slash DD slash YYYY
FEDERAL TAX ID #:*
TYPE OF BUSINESS:*
HAVE YOU FILED BANKRUPTCY WITHIN THE LAST 10 YEARS?*
- Yes
- No
IF YES, WHEN?
LIST COMPLETE NAMES OF ALL OWNERS(S), OFFICER(S) OR PARTNERS
NAME TITLE HOME ADDRESS PHONE SS# DL#

CLICK THE + SIGN TO ADD ADDITIONAL OWNERS
WERE ANY OF THESE PRINCIPLES IN THE BUSINESS BEFORE?*
- Yes
- No
IF SO, GIVE NAME OF BUSINESS AND REASON FOR DISCONTINUING.
NEAREST RELATIVE - NAME, ADDRESS, & PHONE*
TRADE REFERENCES*
Trade Name Address Phone Account #:

CLICK THE + SIGN TO ADD ADDITIONAL REFERENCES
BANK REFERENCES*
Bank Name Address Phone Account #:

CLICK THE + SIGN TO ADD ADDITIONAL REFERENCES
*CONTRACTOR LICENSE #*

*PLEASE ATTACH A COPY OF CONTRACTORS & EPA LICENSE IN ORDER TO PURCHASE EQUIPMENT & REFRIGERANT
File
Max. file size: 512 MB.
*EPA LICENSE #

*PLEASE ATTACH A COPY OF CONTRACTORS & EPA LICENSE IN ORDER TO PURCHASE EQUIPMENT & REFRIGERANT
File
Max. file size: 512 MB.

Credit Terms of Sale
In consideration of the extension of credit by AC Supply Company (hereinafter referred to as AC supply), the undersigned agrees: To pay the balance of the account in full on the designated date following the date of purchase. Our terms are net 10th. All purchases during the month will be billed on a statement dated the 25th and will be due the 10th of the month following the statement. All accounts shall be due and payable at PO Box 11340, Fort Worth, TX 76110. A delinquency charge equal to the lesser of (a) the maximum amount allowed by law; or (b) 18% per annum; computed on the unpaid balance shall be paid as liquidated damages on all accounts not paid in full when due. Any account past due is subject to COD terms; and any reaching its’ credit limit is subject to being placed on hold. To pay all reasonable internal and external charges for collection, including attorney fees and court costs, if the account is placed with an attorney or collection agency. That AC Supply’s standard terms and conditions set forth on its’ invoices shall govern all sales to the undersigned. In the event a legal action is commenced solely to enforce any of the terms of purchase or obligations created hereby or hereinafter, the legal action will be commenced in, and the proper place of trial therefore shall be in Fort Worth, Texas. To provide AC Supply with a list of parties authorized to charge on the account. The undersigned will inform AC Supply immediately by certified mail of any changes in this information or in my/our financial status or my/our interest or position in any partnerships or corporations which purchase materials from AC supply, as well as any employees who are terminated and no longer authorized to purchase on the ABOVE mentioned account. The undersigned hereby authorizes any of the bank or trade references listed in this application to provide AC Supply with any and all information requested. In the event that the Applicant(s) is/are individual(s) or is a partnership, the signing of this Agreement shall constitute authorization under the Fair Credit Reporting Act for AC Supply to utilize consumer credit reporting agencies to provide reports on said individual(s) or partners in order to permit AC Supply to appropriately evaluate the extension of any business credit to the Applicant. By signing below, the undersigned acknowledges, accepts, and agrees to A/C Supply’s terms and conditions and certifies that the information given herein is true and correct.
Company Name*
Name
First Last
Signature
Title*
Date
MM slash DD slash YYYY

CONTINUING GUARANTEE
NOTE: In the event that A/C Supply Company offers extension of credit to the below-named credit applicant and/or guarantors, said extension of credit is issued pursuant to the information and financial representation made herein by said applicant and/or said guarantors. CONTINUING GUARANTEE In consideration of A/C Supply company extending credit to the applicant hereunder, the undersigned unconditionally, personally, jointly and severally guarantee and promise to pay A/C Supply Co., or its assignee, any and all indebtedness of the applicant herein to A/C Supply. This is a continuing guarantee and indemnity of payment for the indebtedness between A/C Supply and the applicant, save that of payment. I hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed, and to all renewals of extension of credit. This guarantee shall continue in effect until the undersigned has notified A/C Supply of its cancellation in writing by certified mail, return receipt requested, or receipt personal delivery to the offices of A/C Supply, 100 Page Ave., Ft. Worth, Texas, 76110. Any cancellation shall not alter or affect any obligation created prior to receipt of such written notice.
Company Business Name:*
Name*
First Last
Signature
Date
MM slash DD slash YYYY

Credit Application

RE: CREDIT AGREEMENT 2023 Dear Prospective Customer:

2023 Credit Application

Step 1 of 3

Credit Terms of Sale

CONTINUING GUARANTEE

NAME	TITLE	HOME ADDRESS	PHONE	SS#	DL#

Trade Name	Address	Phone	Account #:

Bank Name	Address	Phone	Account #: