ITL INC - CREDIT APPLICATION
I/we herewith make application to ITL Inc
(hereinafter “Vendor”) for credit and/or to update and reconfirm of our
existing account and balance. The undersigned gives and grants Vendor, or their
agent, permission to verify or re-verify all information stated herein at any
time. I/we hereby agree that all credit granted and/or extended shall be paid
timely in accordance with Vendor’s normal terms. I/we affirm that all
information supplied is true and correct.
IMPORTANT: Do not leave
this page while filling out the form or you may lose your information. Once
your information is complete, simply click "submit" and the process
is complete.
Email Address (so we can respond to you!):
Full Name of Firm:
Billing Address:
City, State, Zip
Phone Number: Fax Number:
Business Name (DBA):
Street Address:
City, State, Zip
Fed ID No CA Resale No.
Type of Business Years in Business?
Is your business a
A. Single Entity (not a subsidiary) B.
Partnership
C. Corporation State
D. Subsidiary of a Parent Company. Please enter the name and address of
parent company:
Under what other company name have you operated?
Name of Applicant/Owner/Officer: Title:
Spouse Name:
Home Street Address:
Home /City/State/Zip: Home Phone:
Drivers License Number & State:
Social Security Number: Date of Birth:
Name of Nearest Relative Not Living
With You:
Relationship: Phone Number:
Have
you ever filed bankruptcy?
Yes No
If yes, was it
Personal or Business?
When did you file: What City/State:
Bank Name and Branch:
Bank City & State: Account #
Bank Phone Number:
Current Petroleum Supplier 1: How Long?
Current Petroleum Supplier 2: How Long?
Trade Reference 1:
Account Number: Phone Number:
Trade Reference 2:
Account Number: Phone Number:
Estimated monthly usage in gallons:
Accounts Payable Contact Name:
Accounts Payable Phone Number:
ADDITIONAL TERMS AND CONDITIONS:
Default Agreement
Should
Purchaser default on any obligation under this agreement and the Supplier
refers this account to his attorney for collection and/or legal action,
Purchaser agrees as follows: to pay the principal due, attorney fees and all
costs of any nature incurred by the Supplier to pursue the delinquent
obligation. In addition, 25% of the principle amount due shall be added to the
principle as liquidated damages to cover any an all-additional expenses to
Supplier. In the event of a dispute or litigation between the parties, it is
hereby agreed that jurisdiction and venue shall vest in either Los Angeles
County, California, Central District or Orange County, California, Central
District at the sole discretion of the Supplier. All other venues are hereby
expressly waived.
I agree to these Terms & Conditions
Signed by: Title
Print Name: Date:
PRINT AND FAX
THIS REPORT TO (323) 560-1170