Perfect Blend Organics - Credit Application

Business Name

Parent Company

Physical Address

Billing Address

Phone Number

Fax Number

Type of Business

Business Established Year

Years in Business

Taxpayer ID#

UBI#

Principal #1 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Principal #2 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Principal #3 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Insurance Company Name

Address

Contact Name

Phone Number

Certificate of Insurance must be provided to prove coverage for rented or leased equipment with a limit high enough to cover all equipment at any point in time, or Damage Waiver will be charged on each rental contract. Perfect Blend LLC must be listed as the Certificate Holder.

Account #

Type of Account

Bank Name

Address

Contact Name

Phone Number

Contact Name

Phone Number

Email Address

Billing Address or PO Box

PO Required?

Special Billing Instructions

Job Name/Number Required?

Authorized Account Users (if required)

Tax Exemption Certificate? (Attach Copy)

Has the business or any principal ever declared bankruptcy?

If yes, Date Filed

Any outstanding judgments?

Trade Reference Name #1

Contact Name

Phone Number

Email

Trade Reference Name #2

Contact Name

Phone Number

Email

Trade Reference Name #3

Contact Name

Phone Number

Email

(Must be suppliers; 3 minimum)

I Understand and Agree to the Following Terms

The Applicant and each person signing below warrants that the information provided is true and correct, authorizing Perfect Blend, LLC to release this information to credit providers and to obtain credit details from banks, credit bureaus, and creditors. Applicant agrees to notify Perfect Blend, LLC of any material changes.

Payment is due upon receipt of the invoice. Delinquent invoices incur a service charge of the lesser of 1.5% per month (18% APR) or the highest rate permitted by law. Applicant submits to the jurisdiction of Washington courts, with venue in King County, and agrees to pay all collection costs, including reasonable attorney fees (minimum 25% of the outstanding balance).

Perfect Blend, LLC may place delinquent accounts on a cash basis or retrieve equipment without notice. Applicant understands late payment charges do not authorize installment payments unless agreed otherwise. By signing, Applicant agrees to the Rental Agreement Terms and Conditions, available upon request.

Applicant Signature

Date

Personal Guarantee

The undersigned guarantees payment of all monies due to Perfect Blend, LLC from the Applicant, including late charges, collection costs, and attorney fees. The guarantor waives demand notice and consents to extensions without notice, authorizing collateral release at Perfect Blend, LLC’s discretion.

Guarantor Signature

Guarantor SSN

Date

Printed Name

Witness Name

Witness Signature

In order to process your request, this agreement must be signed. Please attach a company credit profile if available.

Attach Files Here