Credit Application Credit Application Customer Name Street Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCellEmail Type of Entity:Choose an entity Corp. Partnership Proprietorship Individual LLC Years Est.[If Individual is Checked Above, Please Skip This Section]A/P Contact Associated Company / Former Business Email Credit Line Requested in Dollars Officers/Owners/Principals/Members:Name Title PhoneSS# Name Title PhoneSS# Business References (current companies/suppliers you have a credit account with):Name PhoneEmail Name PhoneEmail Name PhoneEmail Has Applicant or any Owner, Member, Principal or Officer Ever Filed Bankruptcy?Check one of the following: No Yes If Yes, date filed: Month Day Year Name of entity or person filing bankruptcy: Chapter Filed: Any State or Federal Tax Liens or Unsatisfied Judgments Against Applicant?Check one of the following: No Yes If Yes, date: Month Day Year Taxing Authority Amount:The customer identified above is hereby applying for an open line of credit from Goley Insulation. The information above is for the use of obtaining credit and warranted to be complete and accurate. I/We hereby authorize Goley Insulation 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 the periodic review for maintaining the credit relationship. Payment terms on all invoices are as agreed to at point of sale. Restrictions may be placed on any past due account. A service charge of 1.5% may be assessed on delinquent invoices. Applicant further agrees that the amount of credit desired and approved is not a limitation of liability and the signer(s) agrees that it will be responsible for valid charges in excess of the line of credit. The open credit line and the reduction or cancellation of your open credit line is at the sole discretion of Goley Insulation. In the event of default and this account is turned over to an agency or attorney for collection, the signer(s) agrees to pay all reasonable attorney fees and or costs of collection whether or not suit is filed. The person executing this agreement has the authority to bind the customer and is authorized by the customer to enter into terms and conditions.Customer Name: SignatureTitle Date Month Day Year SignatureTitle Date Month Day Year Authorization to Release Bank/Title Company InformationI hereby authorize the institution named to release information requested for the purpose of obtaining or reviewing the customer’s creditCustomer Signature/TitleDate Month Day Year Institution Account Number PhoneConsent to Obtain Consumer Credit Report The undersigned individual who is the owner of the property or the principal proprietor or partner of the entity applying for credit desires a business relationship with Goley Insulation and recognizes that their individual credit history may be a factor in evaluation of credit line. The undersigned consents to the use of the consumer credit report of the undersigned by Goley Insulation as needed in the credit evaluation process and in review for the purpose of maintaining the credit relationship.SignaturePrinted Name Date Month Day Year SignaturePrinted Name Date Month Day Year Personal Guarantee In consideration, including but not limited to the extension of credit by Goley InsulationName (Debtor) the undersigned Guarantor(s), personally and individually, unconditionally guarantee to Goley Insulation the full and prompt payment of all obligations which Debtor presently or hereinafter may have to Goley Insulation. This may include any losses that Goley Insulation may incur as a result of failure of Debtor to adhere to terms and conditions, including attorney fees and collection fees (whether or not suit is filed). The undersigned Guarantor(s) agree to remain bound by this Personal Guarantee for all purchases of goods and services from Goley Insulation made from the date hereof by Debtor. In the event Debtor defaults in payment to Goley Insulation of any amounts owing, Goley Insulation may seek payment directly from the undersigned Guarantor(s) without the need to first proceed against Debtor. The undersigned Guarantor(s) hereby agree to pay interest on any unpaid balance from the date upon which such balance was due until the date of final payment at 1.5% per month, or if not allowed by law, the maximum legal rate allowed by law. Each of the undersigned Guarantor(s) agree that he, she or it will not be discharged from any of the obligations contained in this Personal Guarantee by reason of any modification or agreement reached between Goley Insulation and Debtor relating to any debt owed by Debtor to Goley Insulation, or by reason of any extension of time for payment or other performance, assignment, or default with respect to such debt, and the undersigned Guarantor(s) hereby waive all right to any notice of any such modification, extension, assignment, or default, and hereby waive any and all requirements of notice of non-performance and demand and all other notices to which the undersigned Guarantor(s) might otherwise be entitled by law, and also waive all demands and proofs of demand. No delay by Goley Insulation in exercising any of its options, powers, or rights under this Personal Guarantee, and/or any partial or single exercise thereof, shall constitute a waiver thereof. No waiver of Goley Insulation’s rights under this Personal Guarantee and no modification or amendment of same shall be deemed to be made by Goley Insulation unless the same shall be in writing, duly signed by an authorized representative of Goley Insulation, and each such waiver (if any) shall apply only with respect to the specific instance involved and shall in no way impair Goley Insulation’s rights, or the undersigned Guarantor(s)’ obligations herein, in any other respects or at any other time. The undersigned as personal Guarantor(s) each recognize that his, her or its individual credit history may be a factor in the evaluation of this Personal Guarantee and hereby consents to the use of a consumer credit report on the undersigned by Goley Insulation in the credit application process and as determined necessary.Signature of GuarantorGuarantor’s Printed Name Date Month Day Year Signature of GuarantorGuarantor’s Printed Name Date Month Day Year Signature of WitnessWitness’ Printed Name Date Month Day Year CommentsThis field is for validation purposes and should be left unchanged.
