1780 S. Buckner-Tarsney Rd, Grain Valley, MO 64029 1-800-MeraVic(637-2842) Fax: 816-228-1630 E-mail:
[email protected] Web-site: www.meravic.com
www.trezo.com
APPLICATION FOR TERMS (Net 30, Dating Terms, 6 Month Payment Plan)
Attach Trade Reference Sheet & Sign Below 1) LEGAL NAME OF BUSINESS: _____________________________________ DBA/AKA:______________________________ 2) NAME PRINCIPAL/PARTNER/OFFICER ____________________________________________________________________ 3) BILLING ADDRESS ____________________________________________________________________________________ 4) SHIPPING ADDRESS(if different than billing) ________________________________________________________________ 5) PHONE__________________________________________ 6) FAX______________________________________________ 7) EMAIL ADDRESS: _____________________________________________________________________________________ 8) YEARS IN BUSINESS: __________ 10) TYPE OF BUSINESS:
_____CORPORATION
9) FEDERAL ID #______________________________________ _____PARTNERSHIP
_____SOLE PROPRIETOR
_____LLC
CREDIT TERMS/CONDITIONS It is acknowledged, understood and agreed that any order for the purchase of goods submitted to MeraVic is subject to final acceptance, including, if relevant, credit approval by MeraVic at the MeraVic Corporate Office, Grain Valley, MO. Terms of sale maybe amended from MeraVic's standard terms at any time by the MeraVic corporate office based upon the credit history of the Applicant/Customer. If, in the event of a sale of goods to Applicant/Customer by MeraVic on credit, Applicant/Customer fails to make payment in full on any invoice by the due date of same, Applicant/Customer agrees to pay interest at the rate of 1.5% per month or the highest rate otherwise allowed by law, whichever is less, on the unpaid invoice amount due from time to time, from the date of such invoice until the same has been paid in full by Applicant/Customer. Any sale of goods by MeraVic to Applicant/Customer, whether on credit or not, shall be subject to the laws of the State of Missouri. Applicant/Customer also agrees that if a lawsuit is instituted by MeraVic to collect any unpaid balance due from Applicant/Customer to MeraVic, such lawsuit may be instituted in the State of Missouri and that the courts of the State of Missouri would have jurisdiction and venue to hear such matter. Applicant/Customer agrees that in the event Applicant/Customer fails to pay any amount due from Applicant/Customer to MeraVic by the due date for the payment of same and MeraVic turns the collection of any such unpaid invoice over to a collection agency or attorney for collection, MeraVic shall be entitled to recover and collect from Applicant/Customer all costs of collecting same incurred by MeraVic, including collection costs, attorney's fees, court costs and expenses reasonably related to the enforcement of MeraVic's right to receive payment from Applicant/Customer. MeraVic reserves the right to reverse any price discounts if invoices are not paid within the terms of sale. Standard MeraVic terms of sale are Net 30 days from date of invoice. Orders are invoiced and dated on the date of shipment. All orders are shipped FOB MeraVic, Grain Valley, Missouri. With signature below, I authorize MeraVic to charge to any credit card I have given to MeraVic for any orders placed with MeraVic by Applicant/Customer and I also hereby authorize any references given to MeraVic by Applicant/Customer to release any information about the Applicant/Customer requested by MeraVic about its financial status and credit record. I certify that my company is engaged as a registered: wholesaler, reseller or manufacturer in the State on record and associated with the State Tax number below or on record. I further certify that if any property so purchased tax free is consumed by the firm, it is subject to Sales or Use Tax.
State Tax Number:______________________________________________________
Authorized Agent:_______________________________________________________ CMH: MY DOC/FORMS/CREDIT APPLICATION 10 15 2016
Date: _____________________________________
